Healthcare Provider Details

I. General information

NPI: 1093895831
Provider Name (Legal Business Name): ZUZANA PLESA EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 GOLF COURSE DRIVE
NICEVILLE FL
32578-1704
US

IV. Provider business mailing address

536 GOLF COURSE DRIVE
NICEVILLE FL
32578-1704
US

V. Phone/Fax

Practice location:
  • Phone: 850-729-3048
  • Fax: 850-729-3048
Mailing address:
  • Phone: 850-729-3048
  • Fax: 850-729-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000309
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 779
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 8726
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: