| Pinellas Vascular | |
|
5880 49th St N Ste 206 St Petersburg FL 33709-2147 | |
| (813) 997-2099 | |
| Not Available |
| Full Name | Pinellas Vascular |
|---|---|
| Speciality | Surgery |
| Location | 5880 49th St N Ste 206, St Petersburg, Florida |
| Authorized Official Name and Position | Avianne Bunnell (OWNER/ PHYSICIAN) |
| Authorized Official Contact | 7279998346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pinellas Vascular 5260 78th Ave N # 2776 Pinellas Park FL 33781-2347 Ph: (727) 999-8346 | Pinellas Vascular 5880 49th St N Ste 206 St Petersburg FL 33709-2147 Ph: (813) 997-2099 |
| NPI Number | 1174173421 |
|---|---|
| Provider Enumeration Date | 09/18/2019 |
| Last Update Date | 09/24/2024 |
| Certification Date | 09/24/2024 |
| Medicare PECOS PAC ID | 8123450384 |
|---|---|
| Medicare Enrollment ID | O20191111000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174173421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | () | Primary |
| Provider Name | Nessa E Miller |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1477715118 PECOS PAC ID: 0941511059 Enrollment ID: I20150616002043 |
| Provider Name | Chelsea Rutherford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740755537 PECOS PAC ID: 2163766429 Enrollment ID: I20181128000960 |
| Provider Name | Avianne Bunnell |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1285066019 PECOS PAC ID: 1658693395 Enrollment ID: I20190617000345 |
| Provider Name | Gayatri Pandey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891474482 PECOS PAC ID: 4981057445 Enrollment ID: I20240131003213 |
| Provider Name | Gisselle Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518713106 PECOS PAC ID: 0244770774 Enrollment ID: I20240910004364 |
| Provider Name | Alexander Kuang-tsu Lu |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1205397650 PECOS PAC ID: 3072848241 Enrollment ID: I20260414001387 |
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