Healthcare Provider Details

I. General information

NPI: 1922777937
Provider Name (Legal Business Name): RACHAEL AMANDA ZIPPER MMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COLLEGE AVE
DAVIE FL
33314-7721
US

IV. Provider business mailing address

2172 NE 61ST CT
FORT LAUDERDALE FL
33308-2134
US

V. Phone/Fax

Practice location:
  • Phone: 800-541-6682
  • Fax:
Mailing address:
  • Phone: 978-590-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: