Healthcare Provider Details

I. General information

NPI: 1508427337
Provider Name (Legal Business Name): WILLIAM CARL MACKENZIE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FOWLER GROVE BLVD STE 360
WINTER GARDEN FL
34787-5597
US

IV. Provider business mailing address

2200 FOWLER GROVE BLVD STE 360
WINTER GARDEN FL
34787-5597
US

V. Phone/Fax

Practice location:
  • Phone: 844-407-4070
  • Fax:
Mailing address:
  • Phone: 844-407-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9112545
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9112545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: