Provider Demographics
NPI:1902238512
Name:ZAGURSKI, AMY LYNN (NP)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LYNN
Last Name:ZAGURSKI
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:1643 LANCASTER DR
Mailing Address - Street 2:STE. 203
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3593
Mailing Address - Country:US
Mailing Address - Phone:817-329-7670
Mailing Address - Fax:817-416-0145
Practice Address - Street 1:1643 LANCASTER DR
Practice Address - Street 2:STE. 203
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3593
Practice Address - Country:US
Practice Address - Phone:817-329-7670
Practice Address - Fax:817-416-0145
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX693166363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310203YMNTMedicare PIN