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General NPI Number Information
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NPI Number | 1285161562
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Entity Type | Individual
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Provider Name | KENNETH MATTHEW ZINO CRNA
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Gender | Male
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 1 ELDER PL
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City | PALM COAST
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State | FL
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Zip | 32164-6252
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Country | US
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Telephone | 478-972-4644
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Fax | 478-972-4644
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Provider Business Mailing Address
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Address Line | 1 ELDER PL
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City | PALM COAST
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State | FL
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Zip | 32164-6252
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Country | US
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Telephone | 478-972-4644
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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 | RN227726
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9396750
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License Number State | FL
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