Provider Demographics
NPI:1265930267
Name:SAADEH, MACKENZIE DONIGAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:DONIGAN
Last Name:SAADEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MACKENZIE
Other - Middle Name:ANNE
Other - Last Name:DONIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3003 W DR MARTIN LUTHER KING JR BLVD BLDG 2ND
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-321-6580
Mailing Address - Fax:813-321-6315
Practice Address - Street 1:3003 W DR MARTIN LUTHER KING JR BLVD FL 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-321-6580
Practice Address - Fax:813-443-8185
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111100363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025161200Medicaid