Provider Demographics
NPI:1093028649
Name:VOSSOS, HELENE BRENDA (NP)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:BRENDA
Last Name:VOSSOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HELENE
Other - Middle Name:BRENDA
Other - Last Name:VOSSOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1220 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2810
Mailing Address - Country:US
Mailing Address - Phone:386-236-1694
Mailing Address - Fax:386-236-1653
Practice Address - Street 1:1220 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2810
Practice Address - Country:US
Practice Address - Phone:386-236-1694
Practice Address - Fax:386-236-1653
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704249321363L00000X
FLARNP9239456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner