=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932077872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MICHELLE VASQUEZ APRN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 S COLLEGE AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77327-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-541-7586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 S COLLEGE AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77327-4503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-541-7586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 1215772
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------