=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730461666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE S ZGIET NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10904 KINGSTON PIKE STE 101
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37934-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-991-7647
-----------------------------------------------------
Fax | 682-503-7500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 VILLAGE LN STE 200
-----------------------------------------------------
City | COLLEYVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76034-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-900-6631
-----------------------------------------------------
Fax | 682-503-7500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 16115
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------