Provider Demographics
NPI:1801863600
Name:ZAWACKI, PAMELA S (ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:ZAWACKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W SOVEREIGN PATH
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8071
Mailing Address - Country:US
Mailing Address - Phone:352-527-0068
Mailing Address - Fax:352-527-8858
Practice Address - Street 1:3700 W SOVEREIGN PATH
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-8071
Practice Address - Country:US
Practice Address - Phone:352-527-0068
Practice Address - Fax:352-527-8858
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9177967363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801863600OtherNPI
FL5935028431021OtherTRICARE
FL346057OtherHEALTHEASE
FL374143OtherSTAYWELL
FLY104KOtherBCBS
FLQ59327Medicare UPIN
FL5935028431021OtherTRICARE