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General NPI Number Information
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NPI Number | 1780127720
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Entity Type | Individual
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Provider Name | VANESSA VERGARA ARNP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 6971 SW 19TH ST
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-4816
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Country | US
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Telephone | 954-857-7787
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Fax |
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Provider Business Mailing Address
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Address Line | 12474 SHORE VIEW DR
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City | FIRESTONE
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State | CO
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Zip | 80504-8214
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Country | US
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Telephone | 954-857-7787
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9319705
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License Number State | FL
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