Healthcare Provider Details

I. General information

NPI: 1508619826
Provider Name (Legal Business Name): ASPEN VAZQUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12729 BARRACK LN
JACKSONVILLE FL
32218-4273
US

IV. Provider business mailing address

12729 BARRACK LN
JACKSONVILLE FL
32218-4273
US

V. Phone/Fax

Practice location:
  • Phone: 904-897-2684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License NumberRN9500150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: