Healthcare Provider Details

I. General information

NPI: 1891509329
Provider Name (Legal Business Name): BROCK J ZANCA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 S 33RD ST
MUSKOGEE OK
74401-5037
US

IV. Provider business mailing address

913 W GRANGER ST
BROKEN ARROW OK
74012-8461
US

V. Phone/Fax

Practice location:
  • Phone: 918-683-1831
  • Fax: 918-687-7043
Mailing address:
  • Phone: 918-637-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number203733
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number203733
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: