Healthcare Provider Details

I. General information

NPI: 1275173783
Provider Name (Legal Business Name): AMY EDANG ZECEVIC PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N MAGNOLIA AVE
ORLANDO FL
32803-3809
US

IV. Provider business mailing address

30138 SADDLEBRED LN # A
MOUNT DORA FL
32757-7848
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-7149
  • Fax: 407-422-0470
Mailing address:
  • Phone: 407-920-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11005593
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11005593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: