Provider Demographics
NPI:1912325333
Name:ZIMMER, GUSTAVA TOWNSEND (CNM)
Entity Type:Individual
Prefix:
First Name:GUSTAVA
Middle Name:TOWNSEND
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:GUSTAVA
Other - Middle Name:TOWNSEND
Other - Last Name:ROSTAN-WRZOSZIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1307 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6543
Mailing Address - Country:US
Mailing Address - Phone:352-368-2238
Mailing Address - Fax:352-368-5042
Practice Address - Street 1:1307 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6543
Practice Address - Country:US
Practice Address - Phone:352-368-2238
Practice Address - Fax:352-368-5042
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9379656363LG0600X, 367A00000X
VA0024173107367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAC001671OtherSTATE LICENSE
MDMZ3831826OtherDEA