Healthcare Provider Details

I. General information

NPI: 1194284935
Provider Name (Legal Business Name): LISA MARIE VACCARO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 N DALE MABRY HWY
TAMPA FL
33614-2665
US

IV. Provider business mailing address

7171 N DALE MABRY HWY
TAMPA FL
33614-2665
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2000
  • Fax: 904-639-2015
Mailing address:
  • Phone: 813-932-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number18651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: