Healthcare Provider Details

I. General information

NPI: 1740043496
Provider Name (Legal Business Name): TONI DZINIC FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S EADS ST APT 1236S
ARLINGTON VA
22202-2960
US

IV. Provider business mailing address

1600 S EADS ST APT 1236S
ARLINGTON VA
22202-2960
US

V. Phone/Fax

Practice location:
  • Phone: 609-638-6841
  • Fax:
Mailing address:
  • Phone: 609-638-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189394
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: