Provider Demographics
NPI:1093355653
Name:VASMOUT, MADISON LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:LYNNE
Last Name:VASMOUT
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 THE GROVE DR STE 280
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8427
Mailing Address - Country:US
Mailing Address - Phone:407-538-0101
Mailing Address - Fax:
Practice Address - Street 1:4750 THE GROVE DR STE 280
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-8427
Practice Address - Country:US
Practice Address - Phone:407-704-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112712207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology