MEDICARE: ZACHARY J PRIETZ CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	205497	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194980029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY J PRIETZ CRNA

Provider Business Mailing Address
First Line	:	PO BOX 22005
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33742-2005
Country	:	US
Telephone Number	:	919-309-5168
Fax Number	:

Provider Business Practice Location Address
First Line	:	12225 28TH ST N
Second Line	:	SUITE A
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-1860
Country	:	US
Telephone Number	:	919-309-5168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	05/13/2011

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