Healthcare Provider Details

I. General information

NPI: 1245915834
Provider Name (Legal Business Name): CARMEN CORONA ZAVALA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W CIRCLE ST
AVON PARK FL
33825-2928
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 863-453-5500
  • Fax: 863-453-5566
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: