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General NPI Number Information
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NPI Number | 1649957820
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Entity Type | Individual
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Provider Name | GRACIELA VASQUEZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 785 ELKRIDGE LANDING RD STE 300
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City | LINTHICUM
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State | MD
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Zip | 21090-2958
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Country | US
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Telephone | 443-275-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 2605 BERT YANCEY DR
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City | EL PASO
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State | TX
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Zip | 79936-2705
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Country | US
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Telephone | 915-867-1967
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 74758
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License Number State | NM
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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 | 1126456
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License Number State | TX
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