Healthcare Provider Details

I. General information

NPI: 1790199552
Provider Name (Legal Business Name): ZHANNA FAGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZHANNA MOSTOVA

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 US HWY 27 N, SUITE 100
SEBRING FL
33870
US

IV. Provider business mailing address

5115 US HWY 27 N, SUITE 100
SEBRING FL
33870
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-2222
  • Fax: 863-382-8765
Mailing address:
  • Phone: 863-385-2222
  • Fax: 863-382-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11027291
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: