Healthcare Provider Details

I. General information

NPI: 1659599447
Provider Name (Legal Business Name): NANCY ROSE ZUKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N STONE ST
DELAND FL
32720-3255
US

IV. Provider business mailing address

1231 ALBERTA ST
LONGWOOD FL
32750-6302
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-1824
  • Fax:
Mailing address:
  • Phone: 989-506-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107164
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: