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General NPI Number Information
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NPI Number | 1104310267
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Entity Type | Individual
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Provider Name | ENRIQUE XAVIER VACA PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 525 S HERCULES AVE STE 102
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City | CLEARWATER
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State | FL
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Zip | 33764-6320
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Country | US
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Telephone | 727-442-6068
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Fax |
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Provider Business Mailing Address
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Address Line | 13324 FAWN LILY DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-0010
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Country | US
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Telephone | 786-382-6911
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Fax |
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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 | PA9110684
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License Number State | FL
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