Healthcare Provider Details

I. General information

NPI: 1447585385
Provider Name (Legal Business Name): ELIZABETH VASQUEZ FNP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 60TH ST RM 908
NEW YORK NY
10022-1730
US

IV. Provider business mailing address

110 E 60TH ST RM 908
NEW YORK NY
10022-1730
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-8300
  • Fax:
Mailing address:
  • Phone: 512-289-4222
  • Fax: 512-462-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number710045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: