Provider Demographics
NPI:1619629656
Name:VASQUEZ, REBECKA ASHLEY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:ASHLEY
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:REBECKA
Other - Middle Name:ASHLEY
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3530 S VAL VISTA DR STE A111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7319
Mailing Address - Country:US
Mailing Address - Phone:480-219-7810
Mailing Address - Fax:480-219-7806
Practice Address - Street 1:3530 S VAL VISTA DR STE A111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7319
Practice Address - Country:US
Practice Address - Phone:480-219-7810
Practice Address - Fax:480-219-7806
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219151163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner