Provider Demographics
NPI:1821421728
Name:ZORN, DEIDRA (NP)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:ZORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEIDRA
Other - Middle Name:
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 GRANITE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7333
Mailing Address - Country:US
Mailing Address - Phone:817-201-9046
Mailing Address - Fax:
Practice Address - Street 1:733 GRANITE RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-7333
Practice Address - Country:US
Practice Address - Phone:817-201-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily