Provider Demographics
NPI:1336659259
Name:VAZQUEZ, BRANDI D (NP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:D
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 TRIUMPH DR
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9679
Mailing Address - Country:US
Mailing Address - Phone:336-471-5576
Mailing Address - Fax:
Practice Address - Street 1:791 BOONE STATION DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9775
Practice Address - Country:US
Practice Address - Phone:336-471-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010009363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care