Provider Demographics
NPI:1609362292
Name:HOLYFIELD, ZESHA C (NP)
Entity Type:Individual
Prefix:
First Name:ZESHA
Middle Name:C
Last Name:HOLYFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 45TH ST APT 10
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1868
Mailing Address - Country:US
Mailing Address - Phone:248-797-8884
Mailing Address - Fax:
Practice Address - Street 1:3076 45TH ST APT 10
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-1868
Practice Address - Country:US
Practice Address - Phone:248-797-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily