Provider Demographics
NPI:1265711501
Name:VIGROUX, BETHANY (PA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:VIGROUX
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 1:7420 AVENIDA DEL MAR APT 2604
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4875
Mailing Address - Country:US
Mailing Address - Phone:508-813-2342
Mailing Address - Fax:
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-7700
Practice Address - Fax:954-893-3799
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7355363A00000X
FLPA9107323363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS040ZOtherMEDICARE PTAN