Provider Demographics
NPI:1649747221
Name:VAZQUEZ, DEANNA RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:RENEE
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 MERRY BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-0142
Mailing Address - Country:US
Mailing Address - Phone:407-257-0351
Mailing Address - Fax:
Practice Address - Street 1:142 W LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2908
Practice Address - Country:US
Practice Address - Phone:407-915-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9353015363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner