Healthcare Provider Details

I. General information

NPI: 1427952480
Provider Name (Legal Business Name): MACKENZIE HERRERA ABRAHAM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACKENZIE CAROLINE HERRERA

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8211
US

IV. Provider business mailing address

14879 FERN HAMMOCK DR W
JACKSONVILLE FL
32258-5154
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-8000
  • Fax:
Mailing address:
  • Phone: 904-806-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11044470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: