Provider Demographics
NPI:1952057903
Name:FORD, ZACHARY MARCUS (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:MARCUS
Last Name:FORD
Suffix:
Gender:M
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 UNITED DR
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-7428
Mailing Address - Country:US
Mailing Address - Phone:618-344-0248
Mailing Address - Fax:
Practice Address - Street 1:101 UNITED DR
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-7428
Practice Address - Country:US
Practice Address - Phone:618-344-9428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily