Healthcare Provider Details

I. General information

NPI: 1275576605
Provider Name (Legal Business Name): KATHRYN K ZAGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6260
  • Fax: 239-343-6259
Mailing address:
  • Phone: 239-343-6260
  • Fax: 239-343-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: