Healthcare Provider Details

I. General information

NPI: 1134023484
Provider Name (Legal Business Name): ZACHARY FLORES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 SKYLINE RIDGE LN SW
TUMWATER WA
98512-1442
US

IV. Provider business mailing address

1676 SKYLINE RIDGE LN SW
TUMWATER WA
98512-1442
US

V. Phone/Fax

Practice location:
  • Phone: 831-406-0425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN.RN.60228767.MSL
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: