Healthcare Provider Details

I. General information

NPI: 1467207720
Provider Name (Legal Business Name): JOSEPH VARGAS PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 411 UNIT 28037
APO AE
09112
US

IV. Provider business mailing address

13552 HERITAGE FARMS DR
GAINESVILLE VA
20155-1333
US

V. Phone/Fax

Practice location:
  • Phone: 551-500-7027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: