Healthcare Provider Details

I. General information

NPI: 1629484365
Provider Name (Legal Business Name): MAYRA P ZIMMERMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 RIGGINS RD
TALLAHASSEE FL
32308-5318
US

IV. Provider business mailing address

PO BOX 13859
TALLAHASSEE FL
32317-3859
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-4134
  • Fax: 850-402-9130
Mailing address:
  • Phone: 850-205-6232
  • Fax: 850-402-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: