Healthcare Provider Details

I. General information

NPI: 1851978845
Provider Name (Legal Business Name): TYLER SCOTT MCKENZIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD FL 32610
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1283 OLANTA HWY
LAKE CITY SC
29560-5351
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0077
  • Fax:
Mailing address:
  • Phone: 184-361-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME170953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: