Provider Demographics
NPI:1639275118
Name:ZILCOSKY, AMY LYNN (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:ZILCOSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-254-4000
Mailing Address - Fax:386-226-4577
Practice Address - Street 1:807 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7271
Practice Address - Country:US
Practice Address - Phone:386-428-5554
Practice Address - Fax:386-428-6291
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPA3751OtherLICENSE
FLP90927Medicare UPIN