Healthcare Provider Details

I. General information

NPI: 1730735325
Provider Name (Legal Business Name): LILIANA ZUCKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2019
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

PO BOX 561722
MIAMI FL
33256-1722
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-2511
  • Fax:
Mailing address:
  • Phone: 786-223-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11002354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: