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General NPI Number Information
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NPI Number | 1144580671
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Entity Type | Individual
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Provider Name | IESHA LORRAINE ZILCOSKY CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 600 E DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-5925
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Country | US
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Telephone | 352-323-5762
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4918
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City | ORLANDO
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State | FL
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Zip | 32802-4918
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Country | US
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Telephone | 407-581-9180
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Fax | 865-560-7066
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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 | ARNP9162313
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License Number State | FL
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