MEDICARE: ELIZABETH VASQUEZ FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP142408	TX

General Provider Information

NPI Number	:	1467009936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH VASQUEZ FNP

Provider Business Mailing Address
First Line	:	2140 BABCOCK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 E SOUTHCROSS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-2263
Country	:	US
Telephone Number	:	210-333-5454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	08/20/2019

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