MEDICARE: DENVER VACCARO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA21424	FL

General Provider Information

NPI Number	:	1669322301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENVER VACCARO

Provider Business Mailing Address
First Line	:	12276 SAN JOSE BLVD STE 508
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8618
Country	:	US
Telephone Number	:	904-886-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD STE 508
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8618
Country	:	US
Telephone Number	:	904-886-3228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ DENVER VACCARO ” Practice Location

Language	Start Address	Practice Location

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