Provider Demographics
NPI:1467600866
Name:VAZQUEZ RODRIGUEZ, ANDRES JESUS (APRN)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:JESUS
Last Name:VAZQUEZ RODRIGUEZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15480 SW 26TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4905
Mailing Address - Country:US
Mailing Address - Phone:786-417-0655
Mailing Address - Fax:
Practice Address - Street 1:1951 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1547
Practice Address - Country:US
Practice Address - Phone:305-774-9570
Practice Address - Fax:305-774-9573
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9457005363LP0808X, 363LP0808X
FLTRN2783273R00000X
FL9457005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No273R00000XHospital UnitsPsychiatric Unit