MEDICARE: MRS. NATALLIA NASTASSIA MCKENZIE NP

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	363LF0000X	Family Nurse Practitioner	11026064	FL

General Provider Information

NPI Number	:	1922791847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALLIA NASTASSIA MCKENZIE NP

Provider Business Mailing Address
First Line	:	2139 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6134
Country	:	US
Telephone Number	:	954-840-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 W SAMPLE RD STE 100
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4043
Country	:	US
Telephone Number	:	954-840-3225
Fax Number	:

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

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	06/03/2024

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