Healthcare Provider Details

I. General information

NPI: 1568562544
Provider Name (Legal Business Name): DONNA ZACK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13340 METRO PKWY STE 200
FORT MYERS FL
33966
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-0550
  • Fax: 239-343-4013
Mailing address:
  • Phone: 239-343-0550
  • Fax: 239-343-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11002328
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN11002328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: