MEDICARE: KATERYNA ZHUKOVA

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	1223G0001X	General Practice Dentistry	DN31103	FL

General Provider Information

NPI Number	:	1295534758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATERYNA ZHUKOVA

Provider Business Mailing Address
First Line	:	11727 ABESS BLVD APT 1315
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6054
Country	:	US
Telephone Number	:	469-422-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 SOLANA RD
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-2297
Country	:	US
Telephone Number	:	904-575-3932
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	12/10/2025

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