Healthcare Provider Details

I. General information

NPI: 1386596948
Provider Name (Legal Business Name): VANESSA ANGELICA BOMBIELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 S VOLUSIA AVE STE 300
ORANGE CITY FL
32763-9129
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11045415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: