Provider Demographics
NPI:1619689684
Name:CHIMEDZA, ZACCHEAUS (FNP)
Entity Type:Individual
Prefix:MR
First Name:ZACCHEAUS
Middle Name:
Last Name:CHIMEDZA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-303-7132
Practice Address - Street 1:2755 MILLER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4164
Practice Address - Country:US
Practice Address - Phone:817-534-7110
Practice Address - Fax:817-413-0521
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily