Healthcare Provider Details

I. General information

NPI: 1417438037
Provider Name (Legal Business Name): ESTEE ZOSMAN LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W PLYMOUTH AVE
DELAND FL
32720-2745
US

IV. Provider business mailing address

403 CROSS ST
DELAND FL
32724-3715
US

V. Phone/Fax

Practice location:
  • Phone: 386-279-0145
  • Fax:
Mailing address:
  • Phone: 305-986-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW368
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: