Healthcare Provider Details

I. General information

NPI: 1770701195
Provider Name (Legal Business Name): CHARLES ANDREW VACCHIANO PH.D., CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

1207 SAVANNAH DR
PANAMA CITY FL
32405-4857
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-6918
  • Fax:
Mailing address:
  • Phone: 850-265-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9176350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: