Provider Demographics
NPI:1083815443
Name:ZAK, JODY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LYNN
Last Name:ZAK
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:25613 FOUNTAIN PARK DR E
Mailing Address - Street 2:APT 203
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2538
Mailing Address - Country:US
Mailing Address - Phone:616-915-3816
Mailing Address - Fax:
Practice Address - Street 1:25613 FOUNTAIN PARK DR E
Practice Address - Street 2:APT 203
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2538
Practice Address - Country:US
Practice Address - Phone:616-915-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant