Provider Demographics
NPI:1104375732
Name:ZACK, RONALD (NP-C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:ZACK
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 N HAYDEN DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4561
Mailing Address - Country:US
Mailing Address - Phone:520-331-3232
Mailing Address - Fax:
Practice Address - Street 1:6630 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-496-4649
Practice Address - Fax:949-695-4900
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN082944163W00000X
AZ259986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse