Provider Demographics
NPI:1992525380
Name:VANEVERY, MARK (CAA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:VANEVERY
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9238 SW 72ND CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-0257
Mailing Address - Country:US
Mailing Address - Phone:248-797-6275
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-273-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125043900Medicaid