Provider Demographics
NPI:1740420926
Name:VISHNAGARA, ASHA ANIL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHA
Middle Name:ANIL
Last Name:VISHNAGARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE #712
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-872-9966
Mailing Address - Fax:615-872-9967
Practice Address - Street 1:6821 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4216
Practice Address - Country:US
Practice Address - Phone:352-331-3353
Practice Address - Fax:352-333-9035
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104306363A00000X
TN2376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJA960YOtherMEDICARE