Provider Demographics
NPI:1134797962
Name:LYNCH, MCKENZIE RETINO
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:RETINO
Last Name:LYNCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:RETINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9174 SW 81ST CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-7846
Mailing Address - Country:US
Mailing Address - Phone:352-509-5201
Mailing Address - Fax:440-569-4072
Practice Address - Street 1:9174 SW 81ST CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7846
Practice Address - Country:US
Practice Address - Phone:352-509-5201
Practice Address - Fax:440-569-4072
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant