Heidi Joan Vassallo, CPHT

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

2901-0104-0755-004 Issued in FL

Practice address

1436 S 6TH St
Macclenny, FL 32063-4623

Phone

(904) 259-5824

Fax

(904) 259-5275

NPI assigned

Sep 25, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Susan Dubose

  • Pharmacy
  • Macclenny, FL
  • NPI 1366721904
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154422145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19699 QUIET WOODS LN",
            "city": "GLEN ST MARY",
            "state": "FL",
            "postal_code": "320402545",
            "telephone_number": "904-259-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 S 6TH ST",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634623",
            "telephone_number": "904-259-5824",
            "fax_number": "904-259-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASSALLO",
        "first_name": "HEIDI",
        "middle_name": "JOAN",
        "name_prefix": "Mrs.",
        "credential": "CPHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "FL",
            "license": "2901-0104-0755-004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel McMahan Thomas, ARNP
• Trong Tan Tran, MD
• Sarah Underwood, APRN
• University of Florida Jacksonville Physicians, Inc.
• Usipn LLC
• Brynne Volner
• Alaina Daniele Waddell, CPHT
• Angela L Waite, RBT, EQUINE SPEC
• Melody Miller Waites, APRN, FNP-C
• Wal-Mart Stores East LP

• Pharmacy Technician in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Pharmacy Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.