Provider Demographics
NPI:1235380643
Name:VAZ, NUTAN JYOTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:NUTAN
Middle Name:JYOTHI
Last Name:VAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NUTAN
Other - Middle Name:JYOTHI
Other - Last Name:VAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2254
Mailing Address - Country:US
Mailing Address - Phone:850-473-3726
Mailing Address - Fax:850-505-0079
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 231
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-469-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001165207R00000X
FLME113167207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14L7ZOtherBCBSFL
FLGH167ZMedicare PIN