Healthcare Provider Details

I. General information

NPI: 1629435037
Provider Name (Legal Business Name): MICHELLE ZIPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8108 N NEBRASKA AVE
TAMPA FL
33604
US

IV. Provider business mailing address

8108 N NEBRASKA AVE
TAMPA FL
33604-3103
US

V. Phone/Fax

Practice location:
  • Phone: 813-712-1930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number9309196
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9309196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: