Healthcare Provider Details

I. General information

NPI: 1366568008
Provider Name (Legal Business Name): ATHENA VANZANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ATHENA MAYERS

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SUNSET DR STE 403
SOUTH MIAMI FL
33143-5026
US

IV. Provider business mailing address

6141 SUNSET DR STE 403
SOUTH MIAMI FL
33143-5026
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-2300
  • Fax: 305-669-8966
Mailing address:
  • Phone: 305-665-2300
  • Fax: 305-669-8966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102679
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPA9102679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: