Provider Demographics
NPI:1164055414
Name:FRANKLIN, ZANTWAN
Entity Type:Individual
Prefix:
First Name:ZANTWAN
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 PAT BOOKER RD APT 121
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2619
Mailing Address - Country:US
Mailing Address - Phone:210-780-1756
Mailing Address - Fax:
Practice Address - Street 1:7828 PAT BOOKER RD APT 121
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2619
Practice Address - Country:US
Practice Address - Phone:210-780-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349385164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse