Healthcare Provider Details

I. General information

NPI: 1992627277
Provider Name (Legal Business Name): MS. OLGA ZIMMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WESTOVER DR # 17442
SANFORD NC
27330-8941
US

IV. Provider business mailing address

500 WESTOVER DR # 17442
SANFORD NC
27330-8941
US

V. Phone/Fax

Practice location:
  • Phone: 917-862-7650
  • Fax:
Mailing address:
  • Phone: 917-862-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: