MEDICARE: JOELLE D VAZQUEZ FNP-BC

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	APRN11028404	FL

General Provider Information

NPI Number	:	1497532006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLE D VAZQUEZ FNP-BC

Provider Business Mailing Address
First Line	:	4525 BYLSMA CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-1810
Country	:	US
Telephone Number	:	850-387-6439
Fax Number	:

Provider Business Practice Location Address
First Line	:	3141 E HIGHWAY 98
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-5415
Country	:	US
Telephone Number	:	850-785-9511
Fax Number	:

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

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	09/08/2023

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