Provider Demographics
NPI:1942471495
Name:ZEFO, DEREK ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ANTHONY
Last Name:ZEFO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W CRYSTAL LAKE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4476
Mailing Address - Country:US
Mailing Address - Phone:407-254-2500
Mailing Address - Fax:074-232-7894
Practice Address - Street 1:25 W CRYSTAL LAKE ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4476
Practice Address - Country:US
Practice Address - Phone:407-254-2500
Practice Address - Fax:407-423-2789
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107959363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant