MEDICARE: DIANELYS HERRERA VAZQUEZ DIANELYS HERRERA

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	11027993	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518740851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANELYS HERRERA VAZQUEZ DIANELYS HERRERA

Provider Business Mailing Address
First Line	:	14502 N DALE MABRY HWY STE 328
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2043
Country	:	US
Telephone Number	:	813-440-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	14502 N DALE MABRY HWY STE 328
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2043
Country	:	US
Telephone Number	:	813-440-6490
Fax Number	:	305-671-3505

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

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/06/2024

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