Healthcare Provider Details

I. General information

NPI: 1912888264
Provider Name (Legal Business Name): JANNET VAZQUEZ MACHADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 SW 72ND AVE STE 303
MIAMI FL
33155-5526
US

IV. Provider business mailing address

4860 SW 72ND AVE STE 303
MIAMI FL
33155-5526
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-1606
  • Fax: 305-591-1618
Mailing address:
  • Phone: 305-591-1606
  • Fax: 305-591-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11042023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: