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Individual

ELIZABETH VIDAL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4020 WINTER GARDEN VINELAND RD STE 101, WINTER GARDEN, FL 34787
(407) 993-6120
Mailing address
4020 WINTER GARDEN VINELAND RD, WINTER GARDEN, FL 34787-9502

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
9110762
FL
363A00000X
Physician Assistant
Primary
9110762
FL

Other

Enumeration date
03/23/2018
Last updated
01/30/2020
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