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General NPI Number Information
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NPI Number | 1235380643
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Entity Type | Individual
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Provider Name | NUTAN JYOTHI VAZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 11850 BLACKFOOT ST NW STE 300
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City | COON RAPIDS
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State | MN
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Zip | 55433-2772
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Country | US
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Telephone | 763-236-0808
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Fax | 763-236-6065
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Provider Business Mailing Address
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Address Line | 245 W AIRPORT BLVD
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City | PENSACOLA
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State | FL
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Zip | 32505-2254
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Country | US
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Telephone | 850-473-3726
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Fax | 850-505-0079
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD-24844
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 162504
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 78892
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME113167
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | PT21148
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License Number State | ND
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 001165
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License Number State | GA
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