Healthcare Provider Details

I. General information

NPI: 1730685694
Provider Name (Legal Business Name): TAMARA JEAN VASQUEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 S HIGHWAY 17 UNIT 10
MURRELLS INLET SC
29576-7657
US

IV. Provider business mailing address

2520 S HIGHWAY 17 UNIT 10
MURRELLS INLET SC
29576-7657
US

V. Phone/Fax

Practice location:
  • Phone: 843-595-2937
  • Fax: 877-958-9064
Mailing address:
  • Phone: 843-595-2937
  • Fax: 877-958-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25138
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: