Provider Demographics
NPI:1104293380
Name:VC-PA FIRST ASSIST, LLC
Entity type:Organization
Organization Name:VC-PA FIRST ASSIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNGR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSAMANO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:727-348-4472
Mailing Address - Street 1:10006 CROSS CREEK BLVD
Mailing Address - Street 2:#449
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2595
Mailing Address - Country:US
Mailing Address - Phone:727-348-4472
Mailing Address - Fax:
Practice Address - Street 1:10006 CROSS CREEK BLVD
Practice Address - Street 2:#449
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2595
Practice Address - Country:US
Practice Address - Phone:727-348-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105825363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty