Provider Demographics
NPI:1346619897
Name:ANDERSON, VINCENZINA NICOLAS (MSPAS, PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:VINCENZINA
Middle Name:NICOLAS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSPAS, PA-C, ATC
Other - Prefix:
Other - First Name:VINCENZINA
Other - Middle Name:NICOLAS
Other - Last Name:TSOURIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3204 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2354
Mailing Address - Country:US
Mailing Address - Phone:740-266-3905
Mailing Address - Fax:
Practice Address - Street 1:3204 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2354
Practice Address - Country:US
Practice Address - Phone:740-266-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant