Provider Demographics
NPI:1821263732
Name:VANSOEST, CLAUDIA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:
Last Name:VANSOEST
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 MONUMENT RD STE 20
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1779
Mailing Address - Country:US
Mailing Address - Phone:904-642-1888
Mailing Address - Fax:904-642-2019
Practice Address - Street 1:3033 MONUMENT RD STE 20
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-1779
Practice Address - Country:US
Practice Address - Phone:904-642-1888
Practice Address - Fax:904-642-2019
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2632363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304295200Medicaid
FL304295200Medicaid