=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679795033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION SURGICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 01/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 EMERALD ISLE PT
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-6748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-394-8971
-----------------------------------------------------
Fax | 321-256-2353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1508 EMERALD ISLE PT
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-6748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-394-8971
-----------------------------------------------------
Fax | 321-256-2353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | YVETTE ZEMBRZUSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-394-8971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | PA 3083
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------