Healthcare Provider Details

I. General information

NPI: 1417612409
Provider Name (Legal Business Name): DONNA ZILLAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4680 LAKE UNDERHILL RD
ORLANDO FL
32807-1182
US

IV. Provider business mailing address

4680 LAKE UNDERHILL RD
ORLANDO FL
32807-1182
US

V. Phone/Fax

Practice location:
  • Phone: 407-904-0137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number9351715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: