Healthcare Provider Details

I. General information

NPI: 1467498675
Provider Name (Legal Business Name): ANGELA J. ZIEBARTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 LAKE RD STE 110
WOODBURY MN
55125-1709
US

IV. Provider business mailing address

4724 N DAVIS HWY
PENSACOLA FL
32503-2339
US

V. Phone/Fax

Practice location:
  • Phone: 651-735-7414
  • Fax: 651-735-1827
Mailing address:
  • Phone: 850-696-4000
  • Fax: 850-607-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME115440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: