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General NPI Number Information
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NPI Number | 1013758549
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Entity Type | Individual
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Provider Name | JOSHUA TRENT VESELY PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 211 RANCHERA ST NW
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City | LIVE OAK
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State | FL
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Zip | 32064-4866
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Country | US
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Telephone | 386-364-1751
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Fax | 386-364-1761
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Provider Business Mailing Address
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Address Line | 23476 NW 186TH AVE
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City | HIGH SPRINGS
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State | FL
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Zip | 32643-0673
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Country | US
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Telephone | 386-454-0698
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Fax | 386-454-0690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119014
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License Number State | FL
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