Provider Demographics
NPI:1285490268
Name:ZACARIAS, KRISTIAN DEVERA (FNP)
Entity type:Individual
Prefix:MR
First Name:KRISTIAN
Middle Name:DEVERA
Last Name:ZACARIAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3039
Mailing Address - Country:US
Mailing Address - Phone:646-423-4602
Mailing Address - Fax:
Practice Address - Street 1:11506 BEACH CHANNEL DR STE 101
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2113
Practice Address - Country:US
Practice Address - Phone:718-474-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily