Provider Demographics
NPI:1639576127
Name:ZAKAIB, NAZISH (PA-C)
Entity Type:Individual
Prefix:
First Name:NAZISH
Middle Name:
Last Name:ZAKAIB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RAY E TALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-6772
Mailing Address - Country:US
Mailing Address - Phone:864-967-7028
Mailing Address - Fax:864-228-0915
Practice Address - Street 1:35 RAY E TALLEY CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6772
Practice Address - Country:US
Practice Address - Phone:864-967-7028
Practice Address - Fax:864-228-0915
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2093PAMedicaid
SC2093PAMedicaid