Healthcare Provider Details

I. General information

NPI: 1588312474
Provider Name (Legal Business Name): PETER ZUCK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

IV. Provider business mailing address

17080 SAFETY ST STE 109
FORT MYERS FL
33908-7506
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1000
  • Fax:
Mailing address:
  • Phone: 239-349-2605
  • Fax: 888-501-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9191668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: