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General NPI Number Information
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NPI Number | 1497240386
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Entity Type | Individual
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Provider Name | JESSICA LYNN ZALUTKO PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 02/20/2021
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Provider Practice Location Address
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Address Line | 925 NE 30TH TER STE 308
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City | HOMESTEAD
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State | FL
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Zip | 33033-7614
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Country | US
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Telephone | 786-670-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 215 SE 8TH AVE APT 2840
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-4053
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Country | US
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Telephone | 908-242-4607
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9111164
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License Number State | FL
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