MEDICARE: TERESA VASQUEZ FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.1000029-NP	CO

General Provider Information

NPI Number	:	1770313199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA VASQUEZ FNP-BC

Provider Business Mailing Address
First Line	:	10422 CHINOOK ST
Second Line	:
City	:	FIRESTONE
State	:	CO
Zip	:	80504-4804
Country	:	US
Telephone Number	:	720-404-1522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 DEXTER ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1503
Country	:	US
Telephone Number	:	303-857-2087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/02/2024

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