Healthcare Provider Details

I. General information

NPI: 1013182880
Provider Name (Legal Business Name): FRANK X VENZARA MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N SYKES CREEK PKWY SUITE A
MERRITT ISLAND FL
32953-3491
US

IV. Provider business mailing address

280 N SYKES CREEK PKWY SUITE A
MERRITT ISLAND FL
32953-3491
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-3882
  • Fax: 321-454-7736
Mailing address:
  • Phone: 321-452-3882
  • Fax: 321-454-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME33725
License Number StateFL

VIII. Authorized Official

Name: FRANK X VENZARA
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 321-452-3882