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General NPI Number Information
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NPI Number | 1407139371
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Entity Type | Individual
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Provider Name | SASHI A ZICKEFOOSE NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 4645 CLYDE MORRIS BLVD STE 408
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City | PORT ORANGE
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State | FL
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Zip | 32129-3005
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Country | US
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Telephone | 386-295-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 3761 S. NOVA RD STE P #1050
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City | PORT ORANGE
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State | FL
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Zip | 32129-4284
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Country | US
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Telephone | 386-886-2492
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN116155
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP4449
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11014840
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License Number State | FL
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