Healthcare Provider Details

I. General information

NPI: 1245915834
Provider Name (Legal Business Name): CARMEN CORONA ZAVALA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 US HIGHWAY 27 N STE 100
SEBRING FL
33870-1323
US

IV. Provider business mailing address

301 BALLARD RD
AVON PARK FL
33825-7408
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-2222
  • Fax:
Mailing address:
  • Phone: 863-991-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: