Provider Demographics
NPI:1720887862
Name:TELLEZ, VANESSA (PA-C)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:
Last Name:TELLEZ
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 1:6832 NW 179TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7422
Mailing Address - Country:US
Mailing Address - Phone:786-263-8743
Mailing Address - Fax:
Practice Address - Street 1:6832 NW 179TH ST APT 105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-7422
Practice Address - Country:US
Practice Address - Phone:786-263-8743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085011158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant