Provider Demographics
NPI:1043346026
Name:MCKENZIE, JAMES M (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 EAGLEMOUNT CIR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3852
Mailing Address - Country:US
Mailing Address - Phone:813-661-1144
Mailing Address - Fax:
Practice Address - Street 1:5711 EAGLEMOUNT CIR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3852
Practice Address - Country:US
Practice Address - Phone:813-661-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101307363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical