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General NPI Number Information
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NPI Number | 1649747221
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Entity Type | Individual
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Provider Name | DEANNA RENEE VAZQUEZ ARNP
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Gender | Male
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 142 W LAKEVIEW AVE
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City | LAKE MARY
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State | FL
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Zip | 32746-2908
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Country | US
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Telephone | 407-915-6570
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Fax |
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Provider Business Mailing Address
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Address Line | 561 MERRY BROOK CIR
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City | SANFORD
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State | FL
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Zip | 32771-0142
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Country | US
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Telephone | 407-257-0351
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9353015
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License Number State | FL
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