Provider Demographics
NPI:1790089100
Name:ZACOUR, NICOLE LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEE
Last Name:ZACOUR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 ROUTE 9 N
Mailing Address - Street 2:FREEHOLD OFFICE PLAZA BLDG #1
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8307
Mailing Address - Country:US
Mailing Address - Phone:732-780-7650
Mailing Address - Fax:732-780-8817
Practice Address - Street 1:4247 ROUTE 9 N
Practice Address - Street 2:FREEHOLD OFFICE PLAZA BLDG #1
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8307
Practice Address - Country:US
Practice Address - Phone:732-780-7650
Practice Address - Fax:732-780-8817
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN574736163W00000X
PASP011183363LF0000X
NJ26NJ00366000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse