Healthcare Provider Details

I. General information

NPI: 1093289563
Provider Name (Legal Business Name): ZACHARY JOSEPH HOVERMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 29TH AVE N STE 200
NASHVILLE TN
37203-6002
US

IV. Provider business mailing address

110 29TH AVE N STE 200
NASHVILLE TN
37203-6002
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4304
  • Fax: 615-327-7940
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199851
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24586
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: