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General NPI Number Information
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NPI Number | 1730581257
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Entity Type | Individual
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Provider Name | VANESSA A HAJZUS PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 6600 CHARING ST
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6110
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Country | US
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Telephone | 904-674-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 234 BROOKLINE TRL
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City | PONTE VEDRA
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State | FL
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Zip | 32081-8491
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Country | US
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Telephone | 434-566-8530
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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 | 2175
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9118949
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License Number State | FL
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