MEDICARE: KAITLIN ASHLEY ZOMPANTI NP

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	163W00000X	Registered Nurse	RN2289441	MA
2	363L00000X	Nurse Practitioner	26NJ14946700	NJ
3	363LF0000X	Family Nurse Practitioner	RN2289441	MA

General Provider Information

NPI Number	:	1639713902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN ASHLEY ZOMPANTI NP

Provider Business Mailing Address
First Line	:	1 BARBARY LN
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1519
Country	:	US
Telephone Number	:	732-947-2355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2137 HWY 35 # 160
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1083
Country	:	US
Telephone Number	:	848-278-7366
Fax Number	:

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

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	02/04/2025

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