Provider Demographics
NPI:1194430116
Name:GUTU, ZORODZAI (FNP)
Entity type:Individual
Prefix:
First Name:ZORODZAI
Middle Name:
Last Name:GUTU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43426 ROBEY SQ
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6785
Mailing Address - Country:US
Mailing Address - Phone:561-449-1922
Mailing Address - Fax:
Practice Address - Street 1:200 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6100
Practice Address - Country:US
Practice Address - Phone:540-338-0032
Practice Address - Fax:540-338-0176
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017568300001Medicaid
VA1194430116Medicaid