Individual ProviderAlisa ZagorodnyNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address9320 State Road 54, Trinity, FL 34655-1808(727) 493-2513(239) 432-8500PECOS EnrollmentBased on the most recent information from CMS, provider Alisa Zagorodny is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:24 AM.Profile DetailsProvider ID1902377567Provider TypeIndividualFull NameZagorodny, AlisaCredentialAPRN, FNP-BCGenderFemaleSole ProprietorNoEnumeration Date12/7/2018Last Updated3/22/2023Contact InformationPractice LocationPractice Address9320 State Road 54, Trinity, FL 34655-1808Phone(727) 493-2513Fax(877) 917-2336Mailing LocationMailing AddressPO Box 102222, Atlanta, GA 30368-2222Phone(239) 432-8500FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense11000471FloridaProvider IdentifiersIDDescriptionIssuerID10708300DescriptionMedicaidIssuerUnlistedFlorida