Provider Demographics
NPI:1508476763
Name:VAZQUEZ, ERMA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERMA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ERMA
Other - Middle Name:
Other - Last Name:MAGNUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1105 CANAVOS CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:VA
Mailing Address - Zip Code:23456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12380 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-1305
Practice Address - Country:US
Practice Address - Phone:757-985-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178032363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily