Provider Demographics
NPI:1497123319
Name:DR LUISA VEGA DNP LLC
Entity Type:Organization
Organization Name:DR LUISA VEGA DNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLER VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:813-403-4423
Mailing Address - Street 1:PO BOX 117746
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7746
Mailing Address - Country:US
Mailing Address - Phone:407-647-2346
Mailing Address - Fax:
Practice Address - Street 1:8416 TIDAL BREEZE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-4722
Practice Address - Country:US
Practice Address - Phone:813-403-4423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9318236364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty