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General NPI Number Information
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NPI Number | 1477737526
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Entity Type | Individual
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Provider Name | VANESSA L GOLDBACH PA
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Gender | Female
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 2441 OAK MYRTLE LN STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6334
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Country | US
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Telephone | 813-406-4835
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Fax | 813-994-4835
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Provider Business Mailing Address
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Address Line | 2441 OAK MYRTLE LN STE 101
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6334
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Country | US
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Telephone | 813-406-4835
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Fax | 813-994-4835
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | PA9103811
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9103811
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License Number State | FL
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