Provider Demographics
NPI:1235767039
Name:BEKO, ZACHARY (CRNA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BEKO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 SE OTIS LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6503
Mailing Address - Country:US
Mailing Address - Phone:714-514-9145
Mailing Address - Fax:
Practice Address - Street 1:3210 SE OTIS LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-6503
Practice Address - Country:US
Practice Address - Phone:714-514-9145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9525294163WS0200X
FL11019619367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool