Healthcare Provider Details

I. General information

NPI: 1336272988
Provider Name (Legal Business Name): DEBORAH ANN VACCARELLO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VONDERBURG DR SUITE 303 E
BRANDON FL
33511-5964
US

IV. Provider business mailing address

500 VONDERBURG DR SUITE 303 E
BRANDON FL
33511-5964
US

V. Phone/Fax

Practice location:
  • Phone: 813-977-0733
  • Fax: 813-971-2230
Mailing address:
  • Phone: 813-977-0733
  • Fax: 813-971-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 1836272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: