Healthcare Provider Details

I. General information

NPI: 1154070969
Provider Name (Legal Business Name): MATTHEW ZINNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 NE 6TH ST APT 312
FORT LAUDERDALE FL
33304-4873
US

IV. Provider business mailing address

421 NE 6TH ST APT 312
FORT LAUDERDALE FL
33304-4873
US

V. Phone/Fax

Practice location:
  • Phone: 919-665-8831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: