MEDICARE: GISELA LISA 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	346525	NY

General Provider Information

NPI Number	:	1821601006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELA LISA VASQUEZ FNP

Provider Business Mailing Address
First Line	:	7916 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6748
Country	:	US
Telephone Number	:	718-406-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	7916 37TH AVE FL 1
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6748
Country	:	US
Telephone Number	:	718-406-9111
Fax Number	:

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

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	03/11/2022

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