Individual
MR. CLARENCE JASON VASTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
13555 W MCDOWELL RD STE 103, GOODYEAR, AZ 85395-2625
(623) 932-1157
(623) 935-1045
Mailing address
3815 E BELL RD STE 4500, PHOENIX, AZ 85032-2171
(602) 633-3848
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP3558
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510044
—
AZ
01
—
Z136913
MEDICARE
AZ
Enumeration date
03/29/2010
Last updated
08/01/2024
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