Healthcare Provider Details

I. General information

NPI: 1396974614
Provider Name (Legal Business Name): TED ROBERT VANA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 E FLETCHER AVE STE D
TAMPA FL
33613-4907
US

IV. Provider business mailing address

14750 NW 77TH CT STE 100
MIAMI LAKES FL
33016-1507
US

V. Phone/Fax

Practice location:
  • Phone: 813-632-8861
  • Fax: 813-977-4907
Mailing address:
  • Phone: 786-758-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberOS 10551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberOS-009175-L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: