Provider Demographics
NPI:1528433117
Name:MCKENZIE, AMBER (ARNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MCKENZIE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3062
Mailing Address - Country:US
Mailing Address - Phone:850-518-7378
Mailing Address - Fax:850-640-4187
Practice Address - Street 1:620 MCKENZIE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3062
Practice Address - Country:US
Practice Address - Phone:850-518-7378
Practice Address - Fax:850-640-4187
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9239601363LP2300X, 363LA2200X, 363LG0600X
AL1-148775163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020109300Medicaid