Provider Demographics
NPI:1144906744
Name:VANHEUSEN, MCKENZIE (MSN, APRN)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:VANHEUSEN
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:VAN HEUSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, APRN
Mailing Address - Street 1:5210 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4518
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-882-9849
Practice Address - Street 1:5210 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4518
Practice Address - Country:US
Practice Address - Phone:813-882-9986
Practice Address - Fax:813-882-9849
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner