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Provider Information for 1023097136

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MR. JEFFREY SCOTT VASTA M.D.

Gender: MALE

Individual NPI: 1023097136

Calendar   Last Updated:  2018-08-29
  Certification Date: 

Details

Name Value
NPI 1023097136
Enumeration Date 2006-01-17
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 3633 LITTLE RD STE 101
TRINITY, FL 34655-1815
United States

Phone: 727-375-2222 | Fax: 866-244-2335
View Map External Link
Primary Practice Address 3633 LITTLE ROAD SUITE 101
TRINITY, FL 34655-1818
United States

Phone: 727-375-2222 | Fax: 866-244-2335
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207R00000X - Internal Medicine FL ME0072377
No 207R00000X - Internal Medicine FL ME72377