MEDICARE: JOSE LUIS VASQUEZ 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN0002658	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	109020	CO

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	:	1649278318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE LUIS VASQUEZ FNP-BC

Provider Business Mailing Address
First Line	:	928 12TH STREET
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631-4024
Country	:	US
Telephone Number	:	970-352-1056
Fax Number	:	970-336-5000

Provider Business Practice Location Address
First Line	:	7871 S. QUEBEC STREET
Second Line	:	SUITE 200
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80130-5861
Country	:	US
Telephone Number	:	303-683-5620
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/04/2016

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