Healthcare Provider Details

I. General information

NPI: 1205459583
Provider Name (Legal Business Name): TAI ZIMMERMAN COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10611 NW SR 20
BRISTOL FL
32424
US

IV. Provider business mailing address

7007 ALHAMBRA DR
TALLAHASSEE FL
32317-9586
US

V. Phone/Fax

Practice location:
  • Phone: 850-643-1033
  • Fax: 850-643-5066
Mailing address:
  • Phone: 850-666-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: