Healthcare Provider Details

I. General information

NPI: 1134821093
Provider Name (Legal Business Name): ALEXANDRA SHAE ZAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING AS4021, CANAL STREET
JACKSONVILLE NC
28540
US

IV. Provider business mailing address

BUILDING AS4021 CANAL STREET
JACKSONVILLE NC
28540
US

V. Phone/Fax

Practice location:
  • Phone: 910-449-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102208688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: