Active NPI
Mary Lou Zentz, PA
- Physician Assistant
- Sebring, FL
National Provider Identifier
1902140874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 2332
- Practice address
- 4200 Sun'N Lake Blvd
Sebring, FL 33872-1986 - Phone
- (863) 402-3402
- Fax
- (863) 402-3166
- NPI assigned
- Nov 16, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 2332 | FL | Primary |
Addresses
Primary practice location
4200 Sun'N Lake Blvd
Sebring, FL 33872-1986
Mailing address
4200 Sun'N Lake Blvd
Sebring, FL 33872-1986
Phone (863) 402-3402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA 2332 | Other | FL | PA LICENSE - STATE OF FLORIDA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 2332 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358726400000",
"number": "1902140874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 SUN'N LAKE BLVD",
"city": "SEBRING",
"state": "FL",
"postal_code": "338721986",
"telephone_number": "863-402-3402",
"fax_number": "863-402-3166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 SUN'N LAKE BLVD",
"city": "SEBRING",
"state": "FL",
"postal_code": "338721986",
"telephone_number": "863-402-3402",
"fax_number": "863-402-3166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZENTZ",
"first_name": "MARY",
"middle_name": "LOU",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-16",
"last_updated": "2013-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA 2332",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE - STATE OF FLORIDA",
"identifier": "PA 2332",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sebring, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.