Provider Demographics
NPI:1508398819
Name:ZAVITSANOS, ANNIE (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:ZAVITSANOS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-728-2500
Mailing Address - Fax:215-728-3639
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2434
Practice Address - Country:US
Practice Address - Phone:215-728-2500
Practice Address - Fax:215-728-3639
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017103363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care