Provider Demographics
NPI:1366568008
Name:VANZANT, ATHENA (PA-C)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:
Last Name:VANZANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:
Other - Last Name:MAYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6141 SUNSET DR STE 403
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5026
Mailing Address - Country:US
Mailing Address - Phone:305-665-2300
Mailing Address - Fax:305-669-8966
Practice Address - Street 1:6141 SUNSET DR STE 403
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5026
Practice Address - Country:US
Practice Address - Phone:305-665-2300
Practice Address - Fax:305-669-8966
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102679363AM0700X, 207RE0101X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
U0060OtherBCBS
FLIB768ZOtherMEDICARE
FL346256OtherAVMED