Healthcare Provider Details

I. General information

NPI: 1871921163
Provider Name (Legal Business Name): VASCULAR ACTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W SAINT ISABEL ST SUITE 102
TAMPA FL
33607-6375
US

IV. Provider business mailing address

230 NE 25TH AVE SUITE 300
OCALA FL
34470-7080
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-8480
  • Fax: 813-872-8579
Mailing address:
  • Phone: 352-789-1816
  • Fax: 888-224-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN W PIZZUTI
Title or Position: CEO
Credential:
Phone: 352-789-1816