Healthcare Provider Details

I. General information

NPI: 1326370271
Provider Name (Legal Business Name): ZOE JAMILA GONZALES-RABATHALY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZOE JAMILA MARTIN PA-C

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S OSCEOLA AVE
ORLANDO FL
32806-5419
US

IV. Provider business mailing address

4243 NW FEDERAL HWY
JENSEN BEACH FL
34957-3600
US

V. Phone/Fax

Practice location:
  • Phone: 800-735-1178
  • Fax: 772-223-6354
Mailing address:
  • Phone: 800-735-1178
  • Fax: 772-223-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106071
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9106071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: