Healthcare Provider Details

I. General information

NPI: 1235319278
Provider Name (Legal Business Name): TRACYE L ZLOBL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 WILLOW PARK DR STE 102
NAPLES FL
34109
US

IV. Provider business mailing address

6610 WILLOW PARK DR STE 102
NAPLES FL
34109
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-3100
  • Fax: 239-262-3101
Mailing address:
  • Phone: 239-262-3100
  • Fax: 239-262-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME90230
License Number StateFL

VIII. Authorized Official

Name: TRACYE L ZLOBL
Title or Position: OWNER
Credential: M.D.
Phone: 239-262-3100