Basic Information
| Provider Information | |||||||||
| NPI: | 1063778256 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELBERN | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1613 N HARRISON PARKWAY | ||||||||
| Address2: | MAILSTOP SH-9A | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382371 | ||||||||
| FaxNumber: | 9548511746 | ||||||||
| Practice Location | |||||||||
| Address1: | 1431 SW 1ST AVE | ||||||||
| Address2: | OCALA REGIONAL MEDICAL CENTER | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524011000 | ||||||||
| FaxNumber: | 9548511746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 09/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | ME123885 | FL | N | Hospitals | General Acute Care Hospital | 207P00000X | ME123885 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.