Provider Demographics
NPI:1396999447
Name:URBINA, VANESSA (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:URBINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 OLD HIGHWAY 441 S STE 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-7039
Mailing Address - Country:US
Mailing Address - Phone:352-605-6958
Mailing Address - Fax:352-729-4278
Practice Address - Street 1:6909 OLD HIGHWAY 441 S STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7039
Practice Address - Country:US
Practice Address - Phone:352-605-6958
Practice Address - Fax:352-309-7579
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35120650208D00000X
FLME122274208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014578200Medicaid