Healthcare Provider Details

I. General information

NPI: 1407677388
Provider Name (Legal Business Name): ANDREW S ZIPP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 12/13/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

1001 NW 13TH ST STE 201
BOCA RATON FL
33486-2269
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-4600
  • Fax:
Mailing address:
  • Phone: 561-955-6663
  • Fax: 561-955-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: