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: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7866 GALL BLVD
ZEPHYRHILLS FL
33541-4302
US

IV. Provider business mailing address

7866 GALL BLVD
ZEPHYRHILLS FL
33541-4302
US

V. Phone/Fax

Practice location:
  • Phone: 813-492-5732
  • Fax:
Mailing address:
  • Phone: 813-492-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: