Healthcare Provider Details

I. General information

NPI: 1730581257
Provider Name (Legal Business Name): VANESSA A HAJZUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA A CLOSE

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 EAGLE HARBOR PKWY STE A
FLEMING ISLAND FL
32003-4821
US

IV. Provider business mailing address

PO BOX 748817
ATLANTA GA
30374-8817
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-9555
  • Fax: 888-540-2519
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2175
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9118949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: