Healthcare Provider Details

I. General information

NPI: 1326614579
Provider Name (Legal Business Name): NICOLE ZARACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

86 DANA AVE APT 207
ALBANY NY
12208-3872
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7000
  • Fax:
Mailing address:
  • Phone: 315-530-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number708507
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2338523
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11016968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: