Provider Demographics
NPI:1508223140
Name:ENVIZION MEDICAL INC
Entity Type:Organization
Organization Name:ENVIZION MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-205-4550
Mailing Address - Street 1:PO BOX 9830
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-9830
Mailing Address - Country:US
Mailing Address - Phone:727-755-0693
Mailing Address - Fax:727-755-0679
Practice Address - Street 1:2711 LETAP CT
Practice Address - Street 2:SUITE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7229
Practice Address - Country:US
Practice Address - Phone:813-279-2211
Practice Address - Fax:813-948-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67888332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site