Healthcare Provider Details

I. General information

NPI: 1467360529
Provider Name (Legal Business Name): MAKAYLA DENISE MACKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W CERVANTES ST
PENSACOLA FL
32501-3128
US

IV. Provider business mailing address

631 GREENBERRY DR
CANTONMENT FL
32533-1432
US

V. Phone/Fax

Practice location:
  • Phone: 850-466-3200
  • Fax:
Mailing address:
  • Phone: 850-324-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: