Healthcare Provider Details

I. General information

NPI: 1265086805
Provider Name (Legal Business Name): GEMA VANEGAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5867 OKEECHOBEE BLVD
WEST PALM BEACH FL
33417-4300
US

IV. Provider business mailing address

2330 S CONGRESS AVE
WEST PALM BEACH FL
33406-7608
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-5849
  • Fax: 561-283-0677
Mailing address:
  • Phone: 561-432-5849
  • Fax: 561-283-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001828
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH20090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: