Healthcare Provider Details

I. General information

NPI: 1598147522
Provider Name (Legal Business Name): JACQUELINE V ZAMORA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 4TH ST NE
WASHINGTON DC
20002-3431
US

IV. Provider business mailing address

1225 4TH ST NE
WASHINGTON DC
20002-3431
US

V. Phone/Fax

Practice location:
  • Phone: 202-347-8512
  • Fax: 202-506-5372
Mailing address:
  • Phone: 202-347-8512
  • Fax: 202-506-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR213274
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180195
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1023583
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: