Healthcare Provider Details

I. General information

NPI: 1902377567
Provider Name (Legal Business Name): ALISA ZAGORODNY APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 727-493-2513
  • Fax: 877-917-2336
Mailing address:
  • Phone: 239-432-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11000471
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: