Healthcare Provider Details

I. General information

NPI: 1487645883
Provider Name (Legal Business Name): JULIA ANN VASTA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 LITTLE RD STE 101
TRINITY FL
34655-1818
US

IV. Provider business mailing address

3633 LITTLE RD STE 101
TRINITY FL
34655-1815
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-2222
  • Fax: 866-244-2335
Mailing address:
  • Phone: 727-375-2222
  • Fax: 866-244-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3052242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: