Healthcare Provider Details

I. General information

NPI: 1407210172
Provider Name (Legal Business Name): THERESA J ZORN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30305 INGALLS CT
WESLEY CHAPEL FL
33543-7875
US

IV. Provider business mailing address

30305 INGALLS CT
WESLEY CHAPEL FL
33543-7875
US

V. Phone/Fax

Practice location:
  • Phone: 509-978-9487
  • Fax:
Mailing address:
  • Phone: 509-978-9487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number24701
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11033734
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60833240
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number24701
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.014173
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: