Provider Demographics
NPI:1467114470
Name:VASQUEZ, EDWARD (APRN AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:APRN AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 GLENVIEW DR STE G
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8335
Mailing Address - Country:US
Mailing Address - Phone:817-284-9225
Mailing Address - Fax:817-590-0079
Practice Address - Street 1:7505 GLENVIEW DR STE G
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8335
Practice Address - Country:US
Practice Address - Phone:817-284-9225
Practice Address - Fax:817-590-0079
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053755363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care