Healthcare Provider Details

I. General information

NPI: 1508488982
Provider Name (Legal Business Name): MS. ROBIN ZIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN ALDERMAN

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 COLONIAL RD STE 100
FORT PIERCE FL
34950-5309
US

IV. Provider business mailing address

2222 COLONIAL RD STE 100
FORT PIERCE FL
34950-5309
US

V. Phone/Fax

Practice location:
  • Phone: 772-489-4726
  • Fax:
Mailing address:
  • Phone: 772-489-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: