Provider Demographics
NPI:1194980029
Name:PRIETZ, ZACHARY J (CRNA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J
Last Name:PRIETZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22005
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33742-2005
Mailing Address - Country:US
Mailing Address - Phone:919-309-5168
Mailing Address - Fax:
Practice Address - Street 1:12225 28TH ST N
Practice Address - Street 2:SUITE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1860
Practice Address - Country:US
Practice Address - Phone:919-309-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC205497367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053246Medicaid
NC2606386Medicare PIN