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: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7741 MARKET ST STE H
WILMINGTON NC
28411-9444
US

IV. Provider business mailing address

7741 MARKET ST STE H
WILMINGTON NC
28411-9444
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 Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11047745
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5025050
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number394159
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: