Provider Demographics
NPI:1639355373
Name:VASCIK, WILLIAM (PA-C, MPAS, MS, ATC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VASCIK
Suffix:
Gender:M
Credentials:PA-C, MPAS, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CLEVELAND AVE
Mailing Address - Street 2:#100
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7180
Mailing Address - Country:US
Mailing Address - Phone:239-936-6778
Mailing Address - Fax:
Practice Address - Street 1:3210 CLEVELAND AVE
Practice Address - Street 2:#100
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7180
Practice Address - Country:US
Practice Address - Phone:239-936-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant