Healthcare Provider Details

I. General information

NPI: 1124498217
Provider Name (Legal Business Name): DALE A. ZIGLEAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

IV. Provider business mailing address

303 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

V. Phone/Fax

Practice location:
  • Phone: 407-450-5985
  • Fax: 407-604-6883
Mailing address:
  • Phone: 407-450-5985
  • Fax: 407-604-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: