Healthcare Provider Details

I. General information

NPI: 1174484232
Provider Name (Legal Business Name): VANESSA AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 BALM RIVERVIEW RD
RIVERVIEW FL
33569-6601
US

IV. Provider business mailing address

708 LITHIA PINECREST RD STE 102
BRANDON FL
33511-6189
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-7116
  • Fax:
Mailing address:
  • Phone: 813-444-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW92774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: