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General NPI Number Information
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NPI Number | 1538869789
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Entity Type | Individual
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Provider Name | SHAQUILLA VAZQUEZ CLARK DNP MSN CRNP FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 11166 FAIRFAX BLVD STE 500
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City | FAIRFAX
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State | VA
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Zip | 22030-5017
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Country | US
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Telephone | 301-715-3010
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Fax | 410-220-8162
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Provider Business Mailing Address
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Address Line | 11166 FAIRFAX BLVD STE 500
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City | FAIRFAX
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State | VA
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Zip | 22030-5017
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Country | US
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Telephone | 301-715-3010
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Fax | 410-220-8162
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4027887
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0036121
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024189531
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1178967
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R193829
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License Number State | MD
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