Healthcare Provider Details

I. General information

NPI: 1770985632
Provider Name (Legal Business Name): ELIZABET VAZQUEZ SERRANO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 N HOMESTEAD BLVD STE 102
HOMESTEAD FL
33030-6236
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 305-664-0067
  • Fax: 305-631-9834
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9366459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: