Provider Demographics
NPI:1386007482
Name:VACCARO, ANN T
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:T
Last Name:VACCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 FENTON PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1651
Mailing Address - Country:US
Mailing Address - Phone:813-310-0764
Mailing Address - Fax:
Practice Address - Street 1:15810 FENTON PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1651
Practice Address - Country:US
Practice Address - Phone:813-310-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691298296Medicaid