Healthcare Provider Details

I. General information

NPI: 1760949838
Provider Name (Legal Business Name): ELIZABETH VAZQUEZ NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/19/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST STE 401A
MIAMI FL
33125-1655
US

IV. Provider business mailing address

1321 NW 14H ST SUITE 200
MIAMI FL
33125
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5554
  • Fax:
Mailing address:
  • Phone: 305-243-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9386746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: