Healthcare Provider Details

I. General information

NPI: 1194215087
Provider Name (Legal Business Name): AIDSHA VAZQUEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6939 CUPSEED LN
HARMONY FL
34773-6052
US

IV. Provider business mailing address

6939 CUPSEED LN
HARMONY FL
34773-6052
US

V. Phone/Fax

Practice location:
  • Phone: 407-761-8346
  • Fax:
Mailing address:
  • Phone: 407-761-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9339887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: