Healthcare Provider Details

I. General information

NPI: 1780159137
Provider Name (Legal Business Name): JESSICA CATHERINE VAZQUEZ DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA CATHERINE MAGUIRE BSN, RN

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 US HIGHWAY 17 N STE 2
HOLLY RIDGE NC
28445-7597
US

IV. Provider business mailing address

214 US HIGHWAY 17 N STE 2
HOLLY RIDGE NC
28445-7597
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-8424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9638096
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: