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General NPI Number Information
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NPI Number | 1922589068
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Entity Type | Individual
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Provider Name | CYNETRA ZOLLICOFFER
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 10208 DOUGLAS OAKS CIR APT 104
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City | TAMPA
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State | FL
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Zip | 33610-8651
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Country | US
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Telephone | 678-499-5745
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Fax |
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Provider Business Mailing Address
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Address Line | 10208 DOUGLAS OAKS CIR APT 104
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City | TAMPA
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State | FL
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Zip | 33610-8651
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Country | US
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Telephone | 678-499-5745
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | K6R7F3A3
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License Number State | GA
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