Provider Demographics
NPI:1750798146
Name:ZINICOLA, KATHLEEN ANASTASIA (CPNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANASTASIA
Last Name:ZINICOLA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANASTASIA
Other - Last Name:BANIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:6230 ROLLING RD STE I / J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2307
Mailing Address - Country:US
Mailing Address - Phone:571-665-6460
Mailing Address - Fax:571-565-6561
Practice Address - Street 1:6230 ROLLING RD STE I / J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2307
Practice Address - Country:US
Practice Address - Phone:571-665-6460
Practice Address - Fax:571-565-6561
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171847363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics