Provider Demographics
NPI:1730534215
Name:NZIVO, SAMMY M (APRN)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:M
Last Name:NZIVO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2690 CHANDLER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4088
Mailing Address - Country:US
Mailing Address - Phone:702-605-3331
Mailing Address - Fax:
Practice Address - Street 1:3030 S JONES BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6793
Practice Address - Country:US
Practice Address - Phone:702-605-3331
Practice Address - Fax:888-422-5095
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily