Healthcare Provider Details

I. General information

NPI: 1326859810
Provider Name (Legal Business Name): MCKENZIE LEIGH EWALD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MCKENZIE COOK

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 MAGUIRE RD STE 2002
OCOEE FL
34761-4742
US

IV. Provider business mailing address

2910 MAGUIRE RD STE 2002
OCOEE FL
34761-4742
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 407-287-1664
  • Fax: 407-287-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11037180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: