MEDICARE: JESSICA CIAK ZOPF CPNP

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	363LP0200X	Pediatric Nurse Practitioner	RN2272892	MA

General Provider Information

NPI Number	:	1588920672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CIAK ZOPF CPNP

Provider Business Mailing Address
First Line	:	132 CENTRAL ST STE 116
Second Line	:
City	:	FOXBORO
State	:	MA
Zip	:	02035-2422
Country	:	US
Telephone Number	:	508-543-6306
Fax Number	:	508-543-2976

Provider Business Practice Location Address
First Line	:	132 CENTRAL ST STE 116
Second Line	:
City	:	FOXBORO
State	:	MA
Zip	:	02035-2422
Country	:	US
Telephone Number	:	508-543-6306
Fax Number	:	508-543-2976

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

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	01/22/2024

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