Healthcare Provider Details

I. General information

NPI: 1457329427
Provider Name (Legal Business Name): MICHAEL ADAM ZINCKGRAF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY #200
SUNRISE FL
33323
US

IV. Provider business mailing address

PO BOX 817737
HOLLYWOOD FL
33081-1737
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24194
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3312342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: