Healthcare Provider Details

I. General information

NPI: 1689938813
Provider Name (Legal Business Name): CARONA MCKENZIE EVADNEY MCKENZIE CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BYERLY WAY NONE
ORLANDO FL
32818
US

IV. Provider business mailing address

1115 BYERLY WAY
ORLANDO FL
32818-5667
US

V. Phone/Fax

Practice location:
  • Phone: 407-247-9566
  • Fax:
Mailing address:
  • Phone: 407-247-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number230813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: