Healthcare Provider Details

I. General information

NPI: 1255291431
Provider Name (Legal Business Name): SUSAN ZINGALLI APRN-PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 LA MANCHA DR
SAINT AUGUSTINE FL
32086-0400
US

IV. Provider business mailing address

594 LA MANCHA DR
SAINT AUGUSTINE FL
32086-0400
US

V. Phone/Fax

Practice location:
  • Phone: 904-728-9426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH11250018
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: