Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 9438270 | FL |
NPI | 1033571930 |
---|---|
Provider Name | Ms. Traci Lynn Zimmer |
First Address | Orange City, FL 32763-2205 |
Second Address | Orange City, FL 32763-2205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 25/08/2020 |