Provider Demographics
NPI:1417731910
Name:TAGAN, OLIVIA ZARZOUR (FNP-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ZARZOUR
Last Name:TAGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:ZARZOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 CITY HALL MALL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 CITY HALL MALL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4754
Practice Address - Country:US
Practice Address - Phone:781-306-5130
Practice Address - Fax:781-306-5083
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2325295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner