Provider Demographics
NPI:1851849145
Name:HOPPNER, VANESSA JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:JEAN
Last Name:HOPPNER
Suffix:
Gender:F
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:PO BOX 100129
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0129
Mailing Address - Country:US
Mailing Address - Phone:352-273-5501
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 650
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2929
Practice Address - Country:US
Practice Address - Phone:312-695-3800
Practice Address - Fax:312-695-3644
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109788363A00000X
IL085007913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018941100Medicaid
FL018941100Medicaid