Healthcare Provider Details

I. General information

NPI: 1225774433
Provider Name (Legal Business Name): MS. KAITLIN R ZUST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

5449 WARD LAKE DR
PORT ORANGE FL
32128-7438
US

V. Phone/Fax

Practice location:
  • Phone: 386-506-1924
  • Fax:
Mailing address:
  • Phone: 386-506-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03220025
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: