Healthcare Provider Details

I. General information

NPI: 1124214820
Provider Name (Legal Business Name): GRETCHEN G ZIMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E 21ST ST
JACKSONVILLE FL
32206-2401
US

IV. Provider business mailing address

653-1 WEST 8TH STREET BOX L-16
JACKSONVILLE FL
32209
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1040
  • Fax: 904-350-9651
Mailing address:
  • Phone: 904-244-3050
  • Fax: 904-244-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: