Provider Demographics
NPI:1487272373
Name:PEIXOTO, VANESSA C (NP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:C
Last Name:PEIXOTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:QUADRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13303 BEEBE ALY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7667
Mailing Address - Country:US
Mailing Address - Phone:609-213-2900
Mailing Address - Fax:
Practice Address - Street 1:10140 CLEAR VISTA ST STE 4
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7151
Practice Address - Country:US
Practice Address - Phone:407-900-7784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020004363L00000X
MARN2325833363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner