Healthcare Provider Details

I. General information

NPI: 1508374992
Provider Name (Legal Business Name): JEFFREY LYNN ZELLERS JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR STE 203
STUART FL
34994-2579
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-5862
  • Fax: 772-288-5874
Mailing address:
  • Phone: 772-288-5862
  • Fax: 772-288-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9384449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: