Provider Demographics
NPI:1073888772
Name:ST HILL, ZACKLYN (RN)
Entity Type:Individual
Prefix:MS
First Name:ZACKLYN
Middle Name:
Last Name:ST HILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-5507
Mailing Address - Country:US
Mailing Address - Phone:718-617-5169
Mailing Address - Fax:
Practice Address - Street 1:1007 EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-5507
Practice Address - Country:US
Practice Address - Phone:718-617-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258940163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse