Healthcare Provider Details

I. General information

NPI: 1477331403
Provider Name (Legal Business Name): JAKE ZINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S UNIVERSITY DR
FT LAUDERDALE FL
33328-2004
US

IV. Provider business mailing address

170 CADY ST
LUDLOW MA
01056-2218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA-105905
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: