Healthcare Provider Details

I. General information

NPI: 1326831744
Provider Name (Legal Business Name): CHRISTINA ZICCARDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E MARION AVE UNIT 119
PUNTA GORDA FL
33950-3715
US

IV. Provider business mailing address

265 E MARION AVE UNIT 119
PUNTA GORDA FL
33950-3715
US

V. Phone/Fax

Practice location:
  • Phone: 941-941-0112
  • Fax: 941-941-0114
Mailing address:
  • Phone: 941-216-5994
  • Fax: 941-941-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: