Individual
AMY GRACE VANOSDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
820 GOODLETTE RD N, NAPLES, FL 34102-5445
(239) 430-3260
Mailing address
820 GOODLETTE RD N, NAPLES, FL 34102-5445
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
9112004
FL
363AS0400X
Surgical Physician Assistant
9112004
FL
Other
Enumeration date
01/28/2019
Last updated
01/28/2019
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