Healthcare Provider Details

I. General information

NPI: 1487534731
Provider Name (Legal Business Name): VANESSA TOMOAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W LIVINGSTON ST BLDG 800
ORLANDO FL
32805-1535
US

IV. Provider business mailing address

232 N ORANGE BLOSSOM TRL
ORLANDO FL
32805-1612
US

V. Phone/Fax

Practice location:
  • Phone: 407-428-5751
  • Fax: 407-428-6204
Mailing address:
  • Phone: 407-428-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121347
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: