Healthcare Provider Details

I. General information

NPI: 1124725916
Provider Name (Legal Business Name): ZACHARY PETER GENNETTE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 LAKEWOOD RANCH BLVD STE 110
LAKEWOOD RANCH FL
34202-5174
US

IV. Provider business mailing address

11161 STATE ROAD 70 E UNIT 110
LAKEWOOD RANCH FL
34202-9407
US

V. Phone/Fax

Practice location:
  • Phone: 941-290-5400
  • Fax: 941-289-2492
Mailing address:
  • Phone: 941-290-5400
  • Fax: 941-289-2492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11024544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: