Provider Demographics
NPI:1932312584
Name:ZANT, CONNIE SUE (APRN-BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUE
Last Name:ZANT
Suffix:
Gender:F
Credentials:APRN-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 WASSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720
Mailing Address - Country:US
Mailing Address - Phone:432-714-4284
Mailing Address - Fax:432-714-4286
Practice Address - Street 1:2601 WASSON DRIVE
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-714-4284
Practice Address - Fax:432-714-4286
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019049801Medicaid
TX8Y8967OtherBLUE CROSS BLUE SHIELD
TX00F17EMedicare PIN
TX019049801Medicaid
TX451845Medicare Oscar/Certification