MEDICARE: TAMARA MCKENZIE

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	101YM0800X	Mental Health Counselor	MH23024	FL

General Provider Information

NPI Number	:	1558807701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA MCKENZIE

Provider Business Mailing Address
First Line	:	909 THOROUGHBRED DR
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-8201
Country	:	US
Telephone Number	:	904-608-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	12086 FORT CAROLINE RD STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2689
Country	:	US
Telephone Number	:	904-608-1775
Fax Number	:

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

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	12/05/2023

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