MEDICARE: TERRISHA MCKENZY REGISTERED NURSE

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	163W00000X	Registered Nurse	RN9630943	FL

General Provider Information

NPI Number	:	1831979293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRISHA MCKENZY REGISTERED NURSE

Provider Business Mailing Address
First Line	:	4410 BESSIE CIR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-3260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4410 BESSIE CIR W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-3260
Country	:	US
Telephone Number	:	904-674-5927
Fax Number	:

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

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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