Provider Demographics
NPI:1033763958
Name:ZAK, ALEXANDRA DEANNA (PNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DEANNA
Last Name:ZAK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2603
Mailing Address - Country:US
Mailing Address - Phone:203-453-5235
Mailing Address - Fax:203-453-6204
Practice Address - Street 1:152 BROAD ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2603
Practice Address - Country:US
Practice Address - Phone:203-453-5235
Practice Address - Fax:203-453-6204
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10953208000000X, 363LP0200X
AZ10953363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics