Healthcare Provider Details

I. General information

NPI: 1922589068
Provider Name (Legal Business Name): CYNETRA ZOLLICOFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 DOUGLAS OAKS CIR APT 104
TAMPA FL
33610-8651
US

IV. Provider business mailing address

10208 DOUGLAS OAKS CIR APT 104
TAMPA FL
33610-8651
US

V. Phone/Fax

Practice location:
  • Phone: 678-499-5745
  • Fax:
Mailing address:
  • Phone: 678-499-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberK6R7F3A3
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: