Healthcare Provider Details

I. General information

NPI: 1477064426
Provider Name (Legal Business Name): GEMMA P VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 MILLENIA LAKES BLVD STE 374
ORLANDO FL
32839-3395
US

IV. Provider business mailing address

5323 MILLENIA LAKES BLVD STE 374
ORLANDO FL
32839-3395
US

V. Phone/Fax

Practice location:
  • Phone: 407-734-4108
  • Fax:
Mailing address:
  • Phone: 407-734-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number348786
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number348786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: