Provider Demographics
NPI:1982650099
Name:VUST, LAVERLE (PA)
Entity Type:Individual
Prefix:
First Name:LAVERLE
Middle Name:
Last Name:VUST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 863997
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3997
Mailing Address - Country:US
Mailing Address - Phone:866-396-6418
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:160 NW 13TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4228
Practice Address - Country:US
Practice Address - Phone:786-243-8000
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA0002491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S59819Medicare UPIN