Healthcare Provider Details

I. General information

NPI: 1205486024
Provider Name (Legal Business Name): MICHELLE ZAPF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 INDUSTRIAL DR STE E
SAINT MARYS GA
31558-4436
US

IV. Provider business mailing address

10175 FORTUNE PKWY UNIT 903
JACKSONVILLE FL
32256-6755
US

V. Phone/Fax

Practice location:
  • Phone: 912-324-5012
  • Fax: 904-538-0714
Mailing address:
  • Phone: 904-538-0713
  • Fax: 904-538-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-98851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: