Provider Demographics
NPI:1205184900
Name:CRAVATTA, VANESSA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:CRAVATTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3385
Mailing Address - Country:US
Mailing Address - Phone:407-898-2767
Mailing Address - Fax:407-898-9443
Practice Address - Street 1:2660 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3385
Practice Address - Country:US
Practice Address - Phone:407-898-2767
Practice Address - Fax:407-898-9443
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278152363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006479900Medicaid