Provider Demographics
NPI:1669448833
Name:ZAGST, BRANDON (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:ZAGST
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 CIELO CT
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-2228
Mailing Address - Country:US
Mailing Address - Phone:724-799-1332
Mailing Address - Fax:
Practice Address - Street 1:1242 CIELO CT
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-2228
Practice Address - Country:US
Practice Address - Phone:724-799-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002273367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101324070Medicaid
PA101324070Medicaid