Provider Demographics
NPI:1598271348
Name:HOLUB, ZACHARY STEPHEN (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:STEPHEN
Last Name:HOLUB
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 NORTHWINDS PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2280
Mailing Address - Country:US
Mailing Address - Phone:678-690-8332
Mailing Address - Fax:678-992-1463
Practice Address - Street 1:2655 NORTHWINDS PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2280
Practice Address - Country:US
Practice Address - Phone:678-690-8332
Practice Address - Fax:678-992-1463
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX823869163W00000X
TXAP136763367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty