Provider Demographics
NPI:1649285230
Name:YEFREMOV, VLADIMIR (PAC)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:YEFREMOV
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 RAVENDALE LN
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-7837
Mailing Address - Country:US
Mailing Address - Phone:727-934-4195
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:5637 MARINE PKWY
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4316
Practice Address - Country:US
Practice Address - Phone:727-845-9115
Practice Address - Fax:727-834-5619
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103553363A00000X
FLPA9103394363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant