Provider Demographics
NPI:1942746037
Name:VANCE, ILANA (PA-C)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:VANCE
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 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:833-625-1604
Practice Address - Street 1:2800 S SEACREST BLVD STE 160
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7943
Practice Address - Country:US
Practice Address - Phone:561-955-4600
Practice Address - Fax:833-625-1606
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110078363A00000X
IL085-007022363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant