Healthcare Provider Details

I. General information

NPI: 1710661707
Provider Name (Legal Business Name): ZHILONG ZHAO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-8209
US

IV. Provider business mailing address

2403 BROWNS MILL RD APT 3
JOHNSON CITY TN
37604-1973
US

V. Phone/Fax

Practice location:
  • Phone: 423-930-8337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34237
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: