Provider Demographics
NPI:1124017223
Name:VAZZANA, FRANK JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JOSEPH
Last Name:VAZZANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SUNFOREST DR STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6327
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-514-8891
Practice Address - Street 1:5130 SUNFOREST DR STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6327
Practice Address - Country:US
Practice Address - Phone:727-824-0780
Practice Address - Fax:813-514-8891
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13353OtherBLUE CROSS BLUE SHIELD
AL00999965Medicaid
FL266188800Medicaid
AL59179539OtherBLUE CROSS BLUE SHIELD
FLC016OtherHEALTH FIRST NETWORK
P00233772OtherMEDICARE RAILROAD
781438OtherAETNA
FL266188800Medicaid
H54954Medicare UPIN