Individual
JUAN CARLOS ZULUAGA BEDOYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A., RN, SA-C,
Contact information
Practice address
5836 STONECREST DR, OLIVE BRANCH, MS 38654-0226
(901) 626-4635
Mailing address
5836 STONECREST DR, OLIVE BRANCH, MS 38654-0226
(901) 626-4635
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
272280
TN
163WR0006X
Registered Nurse First Assistant
RN9625060
FL
246ZC0007X
Surgical Assistant
20-104
TN
363A00000X
Physician Assistant
3009
PR
363AS0400X
Surgical Physician Assistant
3009
PR
Other
Enumeration date
01/26/2020
Last updated
03/02/2026
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