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NPI Code Detail

MEDICARE: KENNETH T. ZYLSTRA PA

MEDICARE: KENNETH T. ZYLSTRA 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
1363A00000XPhysician AssistantPA9104399FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA9104399OTHERFLPA LICENSE

General Provider Information

NPI Number : 1528239662
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH T. ZYLSTRA PA
Provider Business Mailing Address
First Line : 5799 LAKE WORTH RD
Second Line :
City : GREENACRES
State : FL
Zip : 33463-3207
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5799 LAKE WORTH RD
Second Line :
City : GREENACRES
State : FL
Zip : 33463-3207
Country : US
Telephone Number : 305-500-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2008
Last Update Date : 03/15/2026

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