MEDICARE: MICHAEL J. ZARILLA 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	PA 9104038	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA 9104038	OTHER	FL	FLA DOH PA LICENSE #

General Provider Information

NPI Number	:	1386865574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J. ZARILLA PA

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	941-429-3416
Fax Number	:	941-429-3430

Provider Business Practice Location Address
First Line	:	18659 TAMIAMI TRL STE A
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-7388
Country	:	US
Telephone Number	:	941-429-3416
Fax Number	:	941-429-3430

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	04/08/2022

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