Provider Demographics
NPI:1346869179
Name:THIESING, ZACHARY AUSTIN EARL
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:AUSTIN EARL
Last Name:THIESING
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 1:325 VIA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-6624
Mailing Address - Country:US
Mailing Address - Phone:703-909-1448
Mailing Address - Fax:
Practice Address - Street 1:325 VIA DEL SOL DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-6624
Practice Address - Country:US
Practice Address - Phone:703-909-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program