VITIA ANGELA PACK (NPI# 1013133826) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013133826 |
| Entity Type | Individual |
| Full Name | VITIA ANGELA PACK |
| Credential | LICENSED MASSAGE THE |
| Practice Address |
4780 Sw 64th Ave Ste 101 Davie FL 33314-4400 |
| Mailing Address |
4780 Sw 64th Ave Ste 103 Davie FL 33314-4400 |
| Practice Telephone | 9544341705 |
| Practice Fax Number | 9544341882 |
| Mailing Telephone | 9544341705 |
| Mailing Fax Number | 9544341882 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-01-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225700000X | Massage Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 363A00000X | Physician Assistant | PA9106235 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | LICENSE NUMBER | MA31540 | 01 |
| Street Address |
4780 SW 64TH AVE STE 101 |
| City | DAVIE |
| State | FL |
| Zip Code | 33314-4400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609823632 | Associates In Family Practice of Broward LLC | Family Medicine | 4780 Sw 64th Ave Ste 101, Davie, FL 33314 | 2006-05-27 |
| 1558900472 | Associatesmd Medical Group Inc | Family Medicine | 4780 Sw 64th Ave Ste 101, Davie, FL 33314-4400 | 2019-12-23 |
| 1619491859 | Leonila Aban Engelmann | Nurse Practitioner | 4780 Sw 64th Ave Ste 101, Davie, FL 33314-4400 | 2017-07-31 |
| 1174762454 | Deborah Jane Kuiper-tomas | Physician Assistant | 4780 Sw 64th Ave Ste 101, Davie, FL 33314-4400 | 2009-02-11 |
| 1861577025 | David Ira Olinsky | Podiatrist | 4780 Sw 64th Ave Ste 101, Davie, FL 33314-4400 | 2006-10-26 |
| 1275570020 | Matthew Teltser | Internal Medicine | 4780 Sw 64th Ave Ste 101, Davie, FL 33314-4400 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386119949 | Tiffany Allen | Case Manager/Care Coordinator | 6602 Sw 41st Street, Davie, FL 33314 | 2018-10-10 |
| 1053804047 | Shannon Stowe | Specialist/Technologist | 3160 Palm Trace Landings Dr Apt 731, Davie, FL 33314 | 2018-06-13 |
| 1700374238 | Christian D Cameron | Developmental Therapist | 5900 Sw 24th Pl Unit 203, Davie, FL 33314 | 2018-04-30 |
| 1902308836 | Infusion Nurse Experts LLC | Home Health | 4802 Sw 51st Street, Davie, FL 33314 | 2018-03-07 |
| 1134658495 | Luz Arevalo | Behavioral Analyst | 6630 Sw 41 Pl, Davie, FL 33314 | 2017-06-08 |
| 1194253815 | Migdalis Padron | Behavior Technician | 4491 Sw 52nd Ct Apt 8, Fort Lauderdale, FL 33314 | 2017-05-25 |
| 1710240833 | Victor Pabon | Adult Companion | 4828 Sw 47 Lane, Davie, FL 33314 | 2012-06-22 |
| 1437433802 | Laura Maritsa Canciani | Counselor | 6005 Stirling Road #124, Davie, FL 33314 | 2011-10-04 |
| 1770729840 | Therapeeds, Inc. | Occupational Therapist | 5951 Orange Drive, Davie, FL 33314 | 2008-12-19 |
| 1861690851 | Craig Alan Handwerker | Counselor | 4200 Sw 54th Ct, Fort Lauderdale, FL 33314 | 2007-07-11 |
| Find all providers in zip 33314 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356987721 | Pooja Prakash Baviskar | Physician Assistant | 931 Sw 111th Way, Davie, FL 33324-4130 | 2019-11-20 |
| 1396308573 | Carlos Alfredo Mijares | Physician Assistant | 3402 Davie Rd Apt 215, Davie, FL 33314-1623 | 2019-04-15 |
| 1275095051 | Melissa Morlote Triana | Physician Assistant | 5550 S University Dr Apt 7205, Davie, FL 33328-5339 | 2019-04-02 |
| 1669845285 | Carlos A Agudelo | Physician Assistant | 4111 Stirling Rd, Davie, FL 33314-7535 | 2015-11-04 |
| 1851720387 | Angela Kinderman | Physician Assistant | 2840 Sw 75th Way Apt 2410, Davie, FL 33314-1032 | 2013-11-05 |
| 1265438147 | James O'connor | Physician Assistant | 7740 Nova Dr, Suite B-4, Davie, FL 33324 | 2005-06-24 |
| 1275095820 | Abby Bayus | Physician Assistant | 3200 S University Dr, Davie, FL 33328-2018 | 2019-04-03 |
| 1275078388 | Martha Vanessa Garcia-arrese | Physician Assistant | 2337 S University Dr, Davie, FL 33324-5842 | 2016-12-28 |
| 1285183236 | Rudy Anthony Lacosse | Physician Assistant | 4801 S University Dr, Davie, FL 33328-3839 | 2016-09-30 |
| 1558818567 | Amanda White | Physician Assistant | 2337 S University Dr, Davie, FL 33324-5842 | 2016-09-07 |
| Find all providers in DAVIE | ||||
Please comment or provide details below to improve the information on VITIA ANGELA PACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.