Healthcare Provider Details

I. General information

NPI: 1992821623
Provider Name (Legal Business Name): CAROL KAY ZIMMERMAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST SUITE 375
PHOENIX AZ
85006-2754
US

IV. Provider business mailing address

1331 N 7TH ST SUITE 375
PHOENIX AZ
85006-2754
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-0070
  • Fax: 602-322-5076
Mailing address:
  • Phone: 602-307-0070
  • Fax: 602-322-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN017473 AP0334
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: