Provider Demographics
NPI:1578177150
Name:VASQUEZ, CAMIE LYNN (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CAMIE
Middle Name:LYNN
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:CAMIE
Other - Middle Name:LYNN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:5353 W DARTMOUTH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5517
Mailing Address - Country:US
Mailing Address - Phone:303-620-5128
Mailing Address - Fax:
Practice Address - Street 1:5353 W DARTMOUTH AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-5517
Practice Address - Country:US
Practice Address - Phone:303-868-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0996555NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000213185Medicaid