Healthcare Provider Details

I. General information

NPI: 1700960671
Provider Name (Legal Business Name): GINA VACCARO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WASHINGTON AVE STE 230
COOKEVILLE TN
38501-2660
US

IV. Provider business mailing address

PO BOX 440100
NASHVILLE TN
37244-0100
US

V. Phone/Fax

Practice location:
  • Phone: 931-400-0995
  • Fax: 931-284-4714
Mailing address:
  • Phone: 615-329-0570
  • Fax: 615-329-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2004-00613
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD28681
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: