Healthcare Provider Details

I. General information

NPI: 1275494114
Provider Name (Legal Business Name): ANDREW ZEGARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S UNIVERSITY DR
FT LAUDERDALE FL
33328-2004
US

IV. Provider business mailing address

3300 S UNIVERSITY DR
FT LAUDERDALE FL
33328-2004
US

V. Phone/Fax

Practice location:
  • Phone: 800-541-6682
  • Fax:
Mailing address:
  • Phone: 800-541-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: