Provider Demographics
NPI:1194215087
Name:VAZQUEZ, AIDSHA (ARNP)
Entity Type:Individual
Prefix:
First Name:AIDSHA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 CUPSEED LN
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:FL
Mailing Address - Zip Code:34773-6052
Mailing Address - Country:US
Mailing Address - Phone:407-761-8346
Mailing Address - Fax:
Practice Address - Street 1:6939 CUPSEED LN
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:FL
Practice Address - Zip Code:34773-6052
Practice Address - Country:US
Practice Address - Phone:407-761-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9339887363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health