Healthcare Provider Details

I. General information

NPI: 1871207217
Provider Name (Legal Business Name): ALYSSA ERIN ZUKOWSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 GLADES RD STE 110
BOCA RATON FL
33431-6462
US

IV. Provider business mailing address

19560 HAVENSWAY CT
BOCA RATON FL
33498-6209
US

V. Phone/Fax

Practice location:
  • Phone: 561-289-9467
  • Fax:
Mailing address:
  • Phone: 561-445-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11022575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: