Provider Demographics
NPI:1841397809
Name:ZAIDE, AMANDA CLIMACOSA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CLIMACOSA
Last Name:ZAIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440026
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-0001
Mailing Address - Country:US
Mailing Address - Phone:904-778-4448
Mailing Address - Fax:904-778-3634
Practice Address - Street 1:4760 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7327
Practice Address - Country:US
Practice Address - Phone:904-778-4448
Practice Address - Fax:904-778-3634
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254654000Medicaid
FL12899OtherBLUE CROSS BLUE SHIELD
FL830347748OtherHUMANA
FL5949632OtherAETNA
FL830347748OtherHUMANA
FL12899OtherBLUE CROSS BLUE SHIELD