Provider Demographics
NPI:1992042493
Name:VEGA, MEYLIN C (PA)
Entity Type:Individual
Prefix:
First Name:MEYLIN
Middle Name:C
Last Name:VEGA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEYLIN
Other - Middle Name:C
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3319 S STATE ROAD 7
Mailing Address - Street 2:STE 313
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8147
Mailing Address - Country:US
Mailing Address - Phone:772-778-2009
Mailing Address - Fax:
Practice Address - Street 1:1285 36TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4885
Practice Address - Country:US
Practice Address - Phone:772-778-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9107027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant