Provider Demographics
NPI:1376203018
Name:VENSKAUSKAITE, MARIJA (PA)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:VENSKAUSKAITE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5804
Mailing Address - Country:US
Mailing Address - Phone:954-643-8809
Mailing Address - Fax:
Practice Address - Street 1:9901 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5804
Practice Address - Country:US
Practice Address - Phone:954-643-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant