Healthcare Provider Details

I. General information

NPI: 1013880178
Provider Name (Legal Business Name): ZARIFA I MAMATOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST STE 202
ENGLEWOOD OH
45415-1165
US

IV. Provider business mailing address

2530 SUNSET MAPLE DR
TIPP CITY OH
45371-8152
US

V. Phone/Fax

Practice location:
  • Phone: 937-832-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0039872
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: