Healthcare Provider Details

I. General information

NPI: 1417548884
Provider Name (Legal Business Name): MICHAEL JOHN VAZQUEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 302
HOLLYWOOD FL
33026-1532
US

IV. Provider business mailing address

11011 SHERIDAN ST STE 302
HOLLYWOOD FL
33026-1532
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-1500
  • Fax: 954-437-0136
Mailing address:
  • Phone: 954-437-1500
  • Fax: 954-437-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: