Provider Demographics
NPI:1255304093
Name:INGRID ZUMARAN MDPA
Entity Type:Organization
Organization Name:INGRID ZUMARAN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:DZIUBINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-394-1500
Mailing Address - Street 1:9555 SEMINOLE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2562
Mailing Address - Country:US
Mailing Address - Phone:727-394-1500
Mailing Address - Fax:727-394-1505
Practice Address - Street 1:9555 SEMINOLE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2562
Practice Address - Country:US
Practice Address - Phone:727-394-1500
Practice Address - Fax:727-394-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5440Medicare ID - Type UnspecifiedINGRID ZUMARAN MDPA GROUP