Healthcare Provider Details

I. General information

NPI: 1003269119
Provider Name (Legal Business Name): KELLY ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11531 TANGLE STONE DR
GIBSONTON FL
33534-5333
US

IV. Provider business mailing address

11531 TANGLE STONE DR
GIBSONTON FL
33534-5333
US

V. Phone/Fax

Practice location:
  • Phone: 813-759-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: