Provider Demographics
NPI:1609304054
Name:ZISSIMOS, ROSA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:
Last Name:ZISSIMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E OSCEOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1616
Mailing Address - Country:US
Mailing Address - Phone:321-841-1570
Mailing Address - Fax:321-841-1569
Practice Address - Street 1:1001 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1616
Practice Address - Country:US
Practice Address - Phone:321-841-1570
Practice Address - Fax:321-841-1569
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0006681390200000X
FLME1482352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program