Healthcare Provider Details

I. General information

NPI: 1326709262
Provider Name (Legal Business Name): JILA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST STE 400
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

PO BOX 621555
OVIEDO FL
32762-1555
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5600
  • Fax:
Mailing address:
  • Phone: 407-620-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9540352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: