Provider Demographics
NPI:1326370271
Name:GONZALES-RABATHALY, ZOE JAMILA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ZOE
Middle Name:JAMILA
Last Name:GONZALES-RABATHALY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:JAMILA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4243 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3600
Mailing Address - Country:US
Mailing Address - Phone:800-735-1178
Mailing Address - Fax:772-223-6354
Practice Address - Street 1:2800 S OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5419
Practice Address - Country:US
Practice Address - Phone:800-735-1178
Practice Address - Fax:772-223-6354
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106071363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007337700Medicaid
FL007337700Medicaid