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NPI Code Detail

MEDICARE: ALISA ZAGORODNY APRN, FNP-BC

MEDICARE: ALISA ZAGORODNY APRN, FNP-BC
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
1363L00000XNurse PractitionerAPRN11000471FL
2363LF0000XFamily Nurse Practitioner11000471FL

Other Identifiers

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

General Provider Information

NPI Number : 1902377567
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISA ZAGORODNY APRN, FNP-BC
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-432-8500
Fax Number :
Provider Business Practice Location Address
First Line : 9320 STATE ROAD 54
Second Line :
City : TRINITY
State : FL
Zip : 34655-1808
Country : US
Telephone Number : 727-493-2513
Fax Number : 877-917-2336
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2018
Last Update Date : 06/10/2026

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