Healthcare Provider Details

I. General information

NPI: 1477256964
Provider Name (Legal Business Name): YASMIN VAZQUEZ LOPEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MARGARET ST
BRANDON FL
33511-5203
US

IV. Provider business mailing address

109 MARGARET ST
BRANDON FL
33511-5203
US

V. Phone/Fax

Practice location:
  • Phone: 813-769-9571
  • Fax: 813-653-4391
Mailing address:
  • Phone: 813-769-9571
  • Fax: 813-654-2544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: