Healthcare Provider Details

I. General information

NPI: 1306764485
Provider Name (Legal Business Name): MACKENZIE RAE NESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W NORTH BLVD
LEESBURG FL
34748-5044
US

IV. Provider business mailing address

401 W NORTH BLVD
LEESBURG FL
34748-5044
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-4242
  • Fax:
Mailing address:
  • Phone: 352-728-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: