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General NPI Number Information
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NPI Number | 1003298977
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Entity Type | Individual
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Provider Name | KELLY ALISA ZIPKO CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 4101 EVANS AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-9310
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Country | US
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Telephone | 239-939-3456
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Fax | 239-790-2432
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Provider Business Mailing Address
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Address Line | PO BOX 162264
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-2264
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Country | US
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Telephone | 941-792-2020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9298353
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License Number State | FL
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