Healthcare Provider Details

I. General information

NPI: 1134423460
Provider Name (Legal Business Name): JEFFREY CLEOPE ZUMARRAGA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARRISON AVE
PANAMA CITY FL
32405-4542
US

IV. Provider business mailing address

1940 HARRISON AVE
PANAMA CITY FL
32405-4542
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-0017
  • Fax:
Mailing address:
  • Phone: 850-763-0017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9188709
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9188709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: