Provider Demographics
NPI:1659599447
Name:ZUKER, NANCY ROSE (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ROSE
Last Name:ZUKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 ALBERTA ST
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6302
Mailing Address - Country:US
Mailing Address - Phone:989-506-3080
Mailing Address - Fax:
Practice Address - Street 1:809 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3255
Practice Address - Country:US
Practice Address - Phone:386-734-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107164363A00000X
MI5601004146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1152915160OtherBCBSM
MIM02890P17Medicare PIN