Provider Demographics
NPI:1558529412
Name:PETRO, VANESSA MARISSA (RN)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:MARISSA
Last Name:PETRO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 NW 88TH AVE
Mailing Address - Street 2:#129
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6021
Mailing Address - Country:US
Mailing Address - Phone:954-749-1937
Mailing Address - Fax:
Practice Address - Street 1:4118 NW 88TH AVE
Practice Address - Street 2:#129
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6021
Practice Address - Country:US
Practice Address - Phone:954-749-1937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9193753163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical