Provider Demographics
NPI:1073188843
Name:VAZQUEZ, LESLY (FNP)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 NW 98TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2623
Mailing Address - Country:US
Mailing Address - Phone:195-462-7203
Mailing Address - Fax:
Practice Address - Street 1:677 TRACE CIR
Practice Address - Street 2:SUITE # 210
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7802
Practice Address - Country:US
Practice Address - Phone:954-363-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily