Provider Demographics
NPI:1225674088
Name:VASQUEZ, CARLA SAMANTHA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:SAMANTHA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-2661
Practice Address - Fax:336-679-7056
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2470852083P0500X
NC5012577363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine