Provider Demographics
NPI:1790409886
Name:RUIZ-VAZQUEZ, RAWI E (FNP-C)
Entity Type:Individual
Prefix:
First Name:RAWI
Middle Name:E
Last Name:RUIZ-VAZQUEZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E HIGHWAY 50 STE 205A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1975
Mailing Address - Country:US
Mailing Address - Phone:352-717-3474
Mailing Address - Fax:
Practice Address - Street 1:1919 E HIGHWAY 50 STE 205A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1975
Practice Address - Country:US
Practice Address - Phone:352-717-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4357363LF0000X
FLAPRN11027905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily