Provider Demographics
NPI:1821557323
Name:ANTA VERGARA, ZOILA E
Entity type:Individual
Prefix:
First Name:ZOILA
Middle Name:E
Last Name:ANTA VERGARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 NW 79TH AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6323
Mailing Address - Country:US
Mailing Address - Phone:754-244-4322
Mailing Address - Fax:
Practice Address - Street 1:4800 W FLAGLER ST STE 215
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1402
Practice Address - Country:US
Practice Address - Phone:954-368-4786
Practice Address - Fax:954-368-4101
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2024066684363LP0808X
FL11000997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health