Provider Demographics
NPI:1124725916
Name:GENNETTE, ZACHARY PETER (APRN)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:PETER
Last Name:GENNETTE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 DESERT PLAIN CV
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2607
Mailing Address - Country:US
Mailing Address - Phone:941-979-7052
Mailing Address - Fax:
Practice Address - Street 1:316 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8805
Practice Address - Country:US
Practice Address - Phone:941-748-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024544363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care