Healthcare Provider Details

I. General information

NPI: 1235340704
Provider Name (Legal Business Name): MARTHA L MACKAY RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SW 22ND PL
OCALA FL
34474-7065
US

IV. Provider business mailing address

2120 SW 22ND PL
OCALA FL
34474-7065
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-5042
  • Fax: 352-732-6031
Mailing address:
  • Phone: 352-732-5042
  • Fax: 352-732-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 535372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: