Provider Demographics
NPI:1003454349
Name:VINCENT, DAVID ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:VINCENT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SE WALTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7168
Mailing Address - Country:US
Mailing Address - Phone:772-335-0400
Mailing Address - Fax:
Practice Address - Street 1:2550 SE WALTON RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7168
Practice Address - Country:US
Practice Address - Phone:772-335-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant