Healthcare Provider Details

I. General information

NPI: 1235362849
Provider Name (Legal Business Name): MARY ZOCCOLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2009
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

PO BOX 864165
ORLANDO FL
32886-4165
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1121
  • Fax: 844-876-0873
Mailing address:
  • Phone: 317-614-9863
  • Fax: 844-876-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMS117848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: