Provider Demographics
NPI:1598966061
Name:MCKENZIE, NATHALIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:D
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATHALIE
Other - Middle Name:
Other - Last Name:DAUPHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2501 N ORANGE AVE STE 786
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4651
Mailing Address - Country:US
Mailing Address - Phone:407-303-2422
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 786
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4651
Practice Address - Country:US
Practice Address - Phone:407-303-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100220207VX0201X, 207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280428000Medicaid
FLME100220OtherMEDICAL LICENSE
FLME100220OtherMEDICAL LICENSE