Provider Demographics
NPI:1326731571
Name:VAZQUEZ, JENNIFER (PA)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7379
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7379
Mailing Address - Country:US
Mailing Address - Phone:939-253-7057
Mailing Address - Fax:
Practice Address - Street 1:CALLE DE LA CANDELARIA #111 ESTE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5058
Practice Address - Country:US
Practice Address - Phone:787-833-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1711-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical