MEDICARE: COURTNEY ZAKSHEVSKY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9109139	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255827630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ZAKSHEVSKY PA

Provider Business Mailing Address
First Line	:	637 JETSTAR LN
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-5236
Country	:	US
Telephone Number	:	727-254-9187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W DR MARTIN LUTHER KING JR BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6003
Country	:	US
Telephone Number	:	813-694-5824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	06/11/2020

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Directions to “ COURTNEY ZAKSHEVSKY PA” Practice Location

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