Provider Demographics
NPI:1760003842
Name:TIPPENS, ZACHARY RYAN (APRN)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RYAN
Last Name:TIPPENS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 COBB PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4178
Mailing Address - Country:US
Mailing Address - Phone:770-974-3911
Mailing Address - Fax:770-405-0606
Practice Address - Street 1:3540 COBB PKWY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4178
Practice Address - Country:US
Practice Address - Phone:770-974-3911
Practice Address - Fax:770-405-0606
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9467258163W00000X
FLF02200533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN239947OtherSTATE OF GEORGIA
F02200533OtherAMERICAN ACADEMY OF NURSE PACTITIONERS