Provider Demographics
NPI:1881250835
Name:ZACK, JOSHUA BRADFORD (DNP, CRNA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BRADFORD
Last Name:ZACK
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2956
Mailing Address - Country:US
Mailing Address - Phone:217-891-3644
Mailing Address - Fax:
Practice Address - Street 1:45 N MELROSE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2956
Practice Address - Country:US
Practice Address - Phone:217-891-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN194149163W00000X
AZ194149367500000X
NC6159367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse