Provider Demographics
NPI:1568947505
Name:TALIAFERRO, ZACHARY (AGACNP)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:TALIAFERRO
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2927 OAK FALLS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1633
Mailing Address - Country:US
Mailing Address - Phone:903-253-1202
Mailing Address - Fax:
Practice Address - Street 1:4204 GARDENDALE ST STE 312
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3141
Practice Address - Country:US
Practice Address - Phone:210-233-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138932363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care