Provider Demographics
NPI:1275173783
Name:ZECEVIC, AMY EDANG (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:EDANG
Last Name:ZECEVIC
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30138 SADDLEBRED LN # A
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7848
Mailing Address - Country:US
Mailing Address - Phone:407-920-0434
Mailing Address - Fax:
Practice Address - Street 1:736 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3809
Practice Address - Country:US
Practice Address - Phone:407-423-7149
Practice Address - Fax:407-422-0470
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005593363L00000X
FL11005593363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner