Healthcare Provider Details

I. General information

NPI: 1902360837
Provider Name (Legal Business Name): YULIANA ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HEALTH PARK BLVD STE 212
ST AUGUSTINE FL
32086-5797
US

IV. Provider business mailing address

201 HEALTH PARK BLVD STE 212
ST AUGUSTINE FL
32086-5797
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4040
  • Fax: 904-819-4041
Mailing address:
  • Phone: 904-819-4040
  • Fax: 904-819-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: