Provider Demographics
NPI:1255405148
Name:ZACOK, GAIL J (FNP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:J
Last Name:ZACOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:J
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4505 S MARYLAND PKWY
Mailing Address - Street 2:BOX 453020
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89154-9900
Mailing Address - Country:US
Mailing Address - Phone:702-895-4337
Mailing Address - Fax:
Practice Address - Street 1:4505 S MARYLAND PKWY
Practice Address - Street 2:BOX 453020
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89154-9900
Practice Address - Country:US
Practice Address - Phone:702-895-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00419081OtherRR MEDICARE
MO425324902Medicaid
MO000080983Medicare PIN
MO809830115Medicare PIN
MOP32852Medicare UPIN
MOMA1327025Medicare PIN