Healthcare Provider Details

I. General information

NPI: 1295205771
Provider Name (Legal Business Name): MARGARET JANE ZIMMERMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 COLLEGE PKWY STE 300
FORT MYERS FL
33907-5524
US

IV. Provider business mailing address

4705 SOUTH BLVD
CHARLOTTE NC
28217
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-2003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08592
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: