Provider Demographics
NPI:1861198525
Name:VOLLMER, MEREDITH GRACE
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:GRACE
Last Name:VOLLMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 OLD HYDE PARK PL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4095
Mailing Address - Country:US
Mailing Address - Phone:941-302-0432
Mailing Address - Fax:
Practice Address - Street 1:9521 OLD HYDE PARK PL
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-4095
Practice Address - Country:US
Practice Address - Phone:941-302-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 363A00000X
1210980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program