Provider Demographics
NPI:1053060814
Name:CARRIER, MACKENZIE GROMLOVITS (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:GROMLOVITS
Last Name:CARRIER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:RAE
Other - Last Name:GROMLOVITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 OLDE WATERFORD WAY
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4117
Practice Address - Country:US
Practice Address - Phone:910-408-1130
Practice Address - Fax:910-408-1135
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015901363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily