Provider Demographics
NPI:1073251492
Name:ZULUAGA, EDNA M (AP)
Entity type:Individual
Prefix:DR
First Name:EDNA
Middle Name:M
Last Name:ZULUAGA
Suffix:
Gender:F
Credentials:AP
Other - Prefix:DR
Other - First Name:EDNA
Other - Middle Name:MARGARITA
Other - Last Name:ZULUAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AP
Mailing Address - Street 1:2923 RIVER TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7451
Mailing Address - Country:US
Mailing Address - Phone:813-562-1649
Mailing Address - Fax:
Practice Address - Street 1:515 36TH ST W STE D
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2459
Practice Address - Country:US
Practice Address - Phone:941-745-1313
Practice Address - Fax:941-745-1334
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty