Healthcare Provider Details

I. General information

NPI: 1972738730
Provider Name (Legal Business Name): JESSICA MCKELVIE ZELLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 US HIGHWAY 301 N SUITE 102
ELLENTON FL
34222-3531
US

IV. Provider business mailing address

7915 US HIGHWAY 301 N SUITE 102
ELLENTON FL
34222-3531
US

V. Phone/Fax

Practice location:
  • Phone: 941-723-7877
  • Fax: 941-723-7844
Mailing address:
  • Phone: 239-560-8922
  • Fax: 941-723-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9264979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: