Provider Demographics
NPI:1598355596
Name:VASQUEZ, TAMMY L
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:L
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SPRING GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-1774
Mailing Address - Country:US
Mailing Address - Phone:419-262-9134
Mailing Address - Fax:
Practice Address - Street 1:320 SPRING GROVE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1774
Practice Address - Country:US
Practice Address - Phone:419-262-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide