Healthcare Provider Details

I. General information

NPI: 1265069165
Provider Name (Legal Business Name): ANDRES VAZQUEZ M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TAMPA ST FL 15
TAMPA FL
33602-4730
US

IV. Provider business mailing address

400 N TAMPA ST
TAMPA FL
33602-4719
US

V. Phone/Fax

Practice location:
  • Phone: 813-458-8831
  • Fax:
Mailing address:
  • Phone: 813-458-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: