Healthcare Provider Details

I. General information

NPI: 1801567649
Provider Name (Legal Business Name): MCKENZIE ALEXANDRA PAYNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 601
ORLANDO FL
32804-5558
US

IV. Provider business mailing address

590 SAND WEDGE LOOP
APOPKA FL
32712-6054
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: