MEDICARE: NANNY VAZQUEZ

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932665916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANNY VAZQUEZ

Provider Business Mailing Address
First Line	:	2190 PAINTER LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7819
Country	:	US
Telephone Number	:	407-489-3568
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 PLAZA DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-4069
Country	:	US
Telephone Number	:	407-927-1437
Fax Number	:	407-910-4768

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

Provider Enumeration Date	:	02/14/2019
Last Update Date	:	02/14/2019

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Directions to “ NANNY VAZQUEZ ” Practice Location

Language	Start Address	Practice Location

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