Healthcare Provider Details

I. General information

NPI: 1265363592
Provider Name (Legal Business Name): TAMARA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 LOMA CEDRO BND
LEANDER TX
78641-2221
US

IV. Provider business mailing address

532 LOMA CEDRO BND
LEANDER TX
78641-2221
US

V. Phone/Fax

Practice location:
  • Phone: 512-906-6151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1236122
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1236122
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: