Provider Demographics
NPI:1043840929
Name:RICH, MACKENZIE ROSE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:ROSE
Last Name:RICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ROSE
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12190 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5578
Mailing Address - Country:US
Mailing Address - Phone:352-597-1206
Mailing Address - Fax:352-597-1208
Practice Address - Street 1:12190 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5578
Practice Address - Country:US
Practice Address - Phone:352-597-1206
Practice Address - Fax:352-597-1208
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11005767363LF0000X
FLAPRN11005767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily