Provider Demographics
NPI:1356131262
Name:GEBRETSADIK, ZENA
Entity type:Individual
Prefix:MR
First Name:ZENA
Middle Name:
Last Name:GEBRETSADIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 TRANSPARENCY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8262
Mailing Address - Country:US
Mailing Address - Phone:571-733-4899
Mailing Address - Fax:
Practice Address - Street 1:8206 TRANSPARENCY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8262
Practice Address - Country:US
Practice Address - Phone:571-733-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL25000172032.343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)