MEDICARE: MCKENZIE LEIGH EWALD PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11037180	FL

General Provider Information

NPI Number	:	1326859810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE LEIGH EWALD PMHNP-BC

Provider Business Mailing Address
First Line	:	2910 MAGUIRE RD STE 2002
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4742
Country	:	US
Telephone Number	:	407-287-1664
Fax Number	:	407-287-1675

Provider Business Practice Location Address
First Line	:	2910 MAGUIRE RD STE 2002
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4742
Country	:	US
Telephone Number	:	239-690-6906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	02/09/2026

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