Provider Demographics
NPI:1184457418
Name:VECCHIO, MARANDA RAINS (PA)
Entity type:Individual
Prefix:
First Name:MARANDA
Middle Name:RAINS
Last Name:VECCHIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 LAKE ANNE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-5723
Mailing Address - Country:US
Mailing Address - Phone:615-653-7002
Mailing Address - Fax:
Practice Address - Street 1:345 LAKE ANNE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-5723
Practice Address - Country:US
Practice Address - Phone:615-653-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant