Healthcare Provider Details

I. General information

NPI: 1205059839
Provider Name (Legal Business Name): RUTH LIMARIS VAZQUEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 PROFESSIONAL PARK DR
CLARKSVILLE TN
37040-5257
US

IV. Provider business mailing address

881 PROFESSIONAL PARK DR
CLARKSVILLE TN
37040-5257
US

V. Phone/Fax

Practice location:
  • Phone: 931-645-4685
  • Fax: 931-245-2117
Mailing address:
  • Phone: 931-645-4685
  • Fax: 931-245-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number128750
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14583
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: