Provider Demographics
NPI:1316051030
Name:ZITO, DEBORAH LYNN (PA-C,IBCLC)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:ZITO
Suffix:
Gender:F
Credentials:PA-C,IBCLC
Other - Prefix:
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Mailing Address - Street 1:192 DUNBARTON CT
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1013
Mailing Address - Country:US
Mailing Address - Phone:912-638-0782
Mailing Address - Fax:912-554-0344
Practice Address - Street 1:2487 DEMERE RD STE 500
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-5644
Practice Address - Country:US
Practice Address - Phone:912-268-4488
Practice Address - Fax:888-503-7119
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002234363AM0700X, 2080A0000X
GA10875901174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001874AMedicaid
GA002234OtherGA LICENSE