Provider Demographics
NPI:1174252654
Name:MORENO VAZQUEZ, YAMISLEYDIS (ARNP)
Entity Type:Individual
Prefix:DR
First Name:YAMISLEYDIS
Middle Name:
Last Name:MORENO VAZQUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:DR
Other - First Name:YAMISLEYDIS
Other - Middle Name:
Other - Last Name:MORENO VAZQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:18245 NW 68TH AVE APT 626
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3480
Mailing Address - Country:US
Mailing Address - Phone:305-244-1583
Mailing Address - Fax:
Practice Address - Street 1:18245 NW 68TH AVE APT 626
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3480
Practice Address - Country:US
Practice Address - Phone:305-244-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily