Healthcare Provider Details

I. General information

NPI: 1346802295
Provider Name (Legal Business Name): ERIKA DANIELA TACO VASQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/16/2024
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-2608
US

IV. Provider business mailing address

HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT 2799 W GRAND BOULEVARD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax:
Mailing address:
  • Phone: 313-916-8445
  • Fax: 313-916-9434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4351044588
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351044588
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME164909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: