Provider Demographics
NPI:1407583321
Name:NASH, VANESSA NA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NA
Last Name:NASH
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 1:13435 COUNTY ROAD 672 FL FL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-9618
Mailing Address - Country:US
Mailing Address - Phone:813-405-5137
Mailing Address - Fax:
Practice Address - Street 1:13435 COUNTY ROAD 672 FL FL
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-9618
Practice Address - Country:US
Practice Address - Phone:813-405-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider