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General NPI Number Information
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NPI Number | 1114967429
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Entity Type | Individual
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Provider Name | VICTOR NASH NASRALLAH PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 580 W 8TH ST UFJAX - DEPT. OF MEDICINE (GI)
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6533
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Country | US
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Telephone | 904-633-0797
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Fax | 904-633-0028
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Provider Business Mailing Address
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Address Line | 2025 FRONTIS PLAZA BLVD STE 200
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5663
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Country | US
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Telephone | 904-244-3199
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Fax | 904-244-3425
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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 | 101643
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License Number State | NC
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