Healthcare Provider Details

I. General information

NPI: 1508401803
Provider Name (Legal Business Name): VANESSA LENNON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2019
Last Update Date: 11/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6099 FARMERS PL
LAKE WORTH FL
33463-6501
US

IV. Provider business mailing address

4300 S JOG RD UNIT 541771
GREENACRES FL
33454-5078
US

V. Phone/Fax

Practice location:
  • Phone: 954-643-1243
  • Fax:
Mailing address:
  • Phone: 561-247-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9303530
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9303530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: