Healthcare Provider Details

I. General information

NPI: 1518909167
Provider Name (Legal Business Name): ALEXIS AUGUSTINE VAZQUEZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 245
JACKSONVILLE BEACH FL
32250
US

IV. Provider business mailing address

1361 13TH AVE S STE 245
JACKSONVILLE BEACH FL
32250-3238
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-7174
  • Fax: 904-694-0696
Mailing address:
  • Phone: 904-396-0300
  • Fax: 904-396-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS9778
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberOS9778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: