Healthcare Provider Details

I. General information

NPI: 1538634225
Provider Name (Legal Business Name): CODY THOMAS ZYGMONT MSN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 MAIN RD
TIVERTON RI
02878-1334
US

IV. Provider business mailing address

821 MAIN RD
TIVERTON RI
02878-1334
US

V. Phone/Fax

Practice location:
  • Phone: 401-625-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN01932
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: