MEDICARE: GAIL J. ZACOK FNP

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	363LF0000X	Family Nurse Practitioner	APRN002188	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00419081	OTHER	MO	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1255405148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL J. ZACOK FNP

Provider Business Mailing Address
First Line	:	4505 S MARYLAND PKWY
Second Line	:	BOX 453020
City	:	LAS VEGAS
State	:	NV
Zip	:	89154-9900
Country	:	US
Telephone Number	:	702-895-4337
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 S MARYLAND PKWY
Second Line	:	BOX 453020
City	:	LAS VEGAS
State	:	NV
Zip	:	89154-9900
Country	:	US
Telephone Number	:	702-895-3370
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/06/2016

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Directions to “ GAIL J. ZACOK FNP” Practice Location

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