Provider Demographics
NPI:1891491213
Name:ZACROISKY, VANESSA (PA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ZACROISKY
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 1:13355 TAMIAMI TRL UNIT E
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2186
Mailing Address - Country:US
Mailing Address - Phone:414-261-2359
Mailing Address - Fax:941-426-4464
Practice Address - Street 1:13355 TAMIAMI TRL UNIT E
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2186
Practice Address - Country:US
Practice Address - Phone:941-426-1235
Practice Address - Fax:941-426-4464
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117057363A00000X
FL9117057363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant