Basic Information
Provider Information
NPI: 1336305440
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LALOGGIA
FirstName: VANESSA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: ANP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 601 E ROLLINS ST
Address2:  
City: ORLANDO
State: FL
PostalCode: 328031248
CountryCode: US
TelephoneNumber: 4073037283
FaxNumber: 4073030347
Practice Location
Address1: 601 E ROLLINS ST
Address2:  
City: ORLANDO
State: FL
PostalCode: 32803
CountryCode: US
TelephoneNumber: 4073037283
FaxNumber: 4073030347
Other Information
ProviderEnumerationDate: 07/29/2008
LastUpdateDate: 04/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LC0200XAPRN9442349FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine

ID Information
IDTypeStateIssuerDescription
02461330005FL MEDICAID
JE926Z01FLMEDICAREOTHER


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