Healthcare Provider Details

I. General information

NPI: 1265345243
Provider Name (Legal Business Name): VANESSA RENEE VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 DREW ST
CLEARWATER FL
33759-3012
US

IV. Provider business mailing address

3350 WEDGEWOOD WAY
TARPON SPRINGS FL
34688-9238
US

V. Phone/Fax

Practice location:
  • Phone: 727-687-6272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9165791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: