Healthcare Provider Details

I. General information

NPI: 1366218224
Provider Name (Legal Business Name): LIZA RIVERA VAZQUEZ BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRAL FLORIDA KIDNEY CENTER 401 SOUTH CHICKASAW TRAIL,
ORLANDO FL
32825
US

IV. Provider business mailing address

HC 1 BOX 26764
CAGUAS PR
00725-8963
US

V. Phone/Fax

Practice location:
  • Phone: 407-434-8910
  • Fax:
Mailing address:
  • Phone: 254-338-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28462
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number28462
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28462
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: