Provider Demographics
NPI:1003298977
Name:ZIPKO, KELLY ALISA (CRNA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ALISA
Last Name:ZIPKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ALISA
Other - Last Name:VAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 162264
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2264
Mailing Address - Country:US
Mailing Address - Phone:941-792-2020
Mailing Address - Fax:
Practice Address - Street 1:4101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9310
Practice Address - Country:US
Practice Address - Phone:239-939-3456
Practice Address - Fax:239-790-2432
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9298353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered