Individual
MRS. VANESSA MARIE PAULTRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2000 SW ARCHER RD, GAINESVILLE, FL 32608-1136
(352) 273-8656
Mailing address
7782 SW 60TH PL, APT 294, GAINESVILLE, FL 32608-4892
(954) 547-9513
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9108128
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013880800
—
FL
Enumeration date
10/30/2014
Last updated
01/09/2015
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