Healthcare Provider Details

I. General information

NPI: 1295534758
Provider Name (Legal Business Name): KATERYNA ZHUKOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 SOLANA RD
PONTE VEDRA FL
32082-2297
US

IV. Provider business mailing address

11727 ABESS BLVD APT 1315
JACKSONVILLE FL
32225-6054
US

V. Phone/Fax

Practice location:
  • Phone: 904-575-3932
  • Fax:
Mailing address:
  • Phone: 469-422-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: