Healthcare Provider Details

I. General information

NPI: 1164311734
Provider Name (Legal Business Name): GRACE DIRECT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CLARK RD STE 140
SARASOTA FL
34231-8433
US

IV. Provider business mailing address

3333 CLARK RD STE 140
SARASOTA FL
34231-8433
US

V. Phone/Fax

Practice location:
  • Phone: 941-210-0244
  • Fax: 941-210-0255
Mailing address:
  • Phone: 941-210-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIANN ZAKI
Title or Position: CEO
Credential: DO
Phone: 941-210-0244