Provider Demographics
NPI:1235435975
Name:VAZQUEZ, YVETTE E
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:E
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:561-477-7700
Mailing Address - Fax:561-477-7707
Practice Address - Street 1:19615 STATE ROAD 7
Practice Address - Street 2:STE 32
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4700
Practice Address - Country:US
Practice Address - Phone:561-477-7700
Practice Address - Fax:561-477-7707
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003884000Medicaid