Healthcare Provider Details

I. General information

NPI: 1306611868
Provider Name (Legal Business Name): CHRISTINE ZAGARELLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 02/07/2024
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N MAIN ST STE 1B
PRESCOTT VALLEY AZ
86314-1215
US

IV. Provider business mailing address

3001 N MAIN ST STE 1B
PRESCOTT VALLEY AZ
86314-1215
US

V. Phone/Fax

Practice location:
  • Phone: 207-321-9211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number246061
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: