Healthcare Provider Details

I. General information

NPI: 1629540133
Provider Name (Legal Business Name): CAROL ZAPALA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORIDA BLUE CENTER IN THE MARKET AT TOWN CENTER 4855 TOWN CENTER PARKWAY
JACKSONVILLE FL
32246-8437
US

IV. Provider business mailing address

FLORIDA BLUE CENTER IN THE MARKET AT TOWN CENTER 4855 TOWN CENTER PARKWAY
JACKSONVILLE FL
32246-8437
US

V. Phone/Fax

Practice location:
  • Phone: 904-363-5870
  • Fax:
Mailing address:
  • Phone: 904-363-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9202666
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: