Healthcare Provider Details

I. General information

NPI: 1487045126
Provider Name (Legal Business Name): JOSEPH SCOTT ZOLLER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST STE 705
SARASOTA FL
34239-2913
US

IV. Provider business mailing address

1921 WALDEMERE ST STE 705
SARASOTA FL
34239-2913
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-5864
  • Fax: 941-316-9819
Mailing address:
  • Phone: 941-366-5864
  • Fax: 941-316-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: