Healthcare Provider Details

I. General information

NPI: 1336237569
Provider Name (Legal Business Name): VINCENT VANWINKLE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BEE RIDGE RD STE E BLDG E
SARASOTA FL
34233
US

IV. Provider business mailing address

3920 BEE RIDGE RD STE E BLDG E
SARASOTA FL
34233
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-1861
  • Fax: 941-927-8491
Mailing address:
  • Phone: 941-923-1861
  • Fax: 941-927-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME44850
License Number StateFL

VIII. Authorized Official

Name: MR. VINCENT J VANWINKLE
Title or Position: PHYSICIAN
Credential: MD PA
Phone: 941-923-1861