Healthcare Provider Details

I. General information

NPI: 1821557323
Provider Name (Legal Business Name): ZOILA E ANTA VERGARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 W FLAGLER ST STE 215
CORAL GABLES FL
33134-1402
US

IV. Provider business mailing address

4420 NW 79TH AVE APT 1F
DORAL FL
33166-6323
US

V. Phone/Fax

Practice location:
  • Phone: 954-368-4786
  • Fax: 954-368-4101
Mailing address:
  • Phone: 754-244-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024066684
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: