Healthcare Provider Details

I. General information

NPI: 1104284132
Provider Name (Legal Business Name): BRANDI ZAVALA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 W HIGHWAY 82
GAINESVILLE TX
76240-2051
US

IV. Provider business mailing address

2024 W HIGHWAY 82
GAINESVILLE TX
76240-2051
US

V. Phone/Fax

Practice location:
  • Phone: 940-612-8760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116112
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: