Provider Demographics
NPI:1437164092
Name:VETROSKY, DANIEL T (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:VETROSKY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BRENT LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2003
Mailing Address - Country:US
Mailing Address - Phone:850-477-5437
Mailing Address - Fax:850-484-4283
Practice Address - Street 1:545 BRENT LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2003
Practice Address - Country:US
Practice Address - Phone:850-477-5437
Practice Address - Fax:850-484-4283
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7169391OtherAETNA
FLE8078YMedicare ID - Type Unspecified
FL7169391OtherAETNA