Provider Demographics
NPI:1790071066
Name:INACIO, VANESSA DE OLIVEIRA (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:DE OLIVEIRA
Last Name:INACIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:DE OLIVEIRA INACIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:877-319-1851
Practice Address - Street 1:1301 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3900
Practice Address - Country:US
Practice Address - Phone:954-971-2266
Practice Address - Fax:877-319-1851
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT200416207Q00000X
FLME120396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012494700Medicaid
FL14VJ8OtherBLUE CROSS BLUE SHIELD
FLHW788ZMedicare PIN