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General NPI Number Information
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NPI Number | 1982152054
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Entity Type | Organization
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Legal Business Name | VAXONSITE, LLC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 1434 JAM LN
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City | ODESSA
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State | FL
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Zip | 33556-3704
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Country | US
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Telephone | 727-489-4358
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Fax | 813-342-7934
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Provider Business Mailing Address
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Address Line | PO BOX 1166
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City | ODESSA
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State | FL
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Zip | 33556-1051
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Country | US
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Telephone | 727-489-4358
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Fax | 813-342-7934
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Authorized Official
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Title or Position | PRESIDENT/CFO
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Name | MR. SEAN P CURTIN
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Credential |
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Telephone | 727-489-4358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | HCC10745
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License Number State | FL
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