Provider Demographics
NPI:1942728902
Name:ZOUMBERIS, KATHRYN MARY (RN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MARY
Last Name:ZOUMBERIS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:MARY
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1700 MANCHESTER CT N
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5237
Mailing Address - Country:US
Mailing Address - Phone:904-610-5306
Mailing Address - Fax:904-702-1831
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-702-1541
Practice Address - Fax:904-702-1831
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN933002163W00000X, 163WD0400X
FL08723574163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse