Provider Demographics
NPI:1982452850
Name:VENTURELLI, JUSTIN ALEXANDER (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ALEXANDER
Last Name:VENTURELLI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3933 BIBB LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1633
Mailing Address - Country:US
Mailing Address - Phone:321-750-6721
Mailing Address - Fax:
Practice Address - Street 1:3933 BIBB LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1633
Practice Address - Country:US
Practice Address - Phone:321-750-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant