Provider Demographics
NPI:1861031338
Name:VAZQUEZ, ANISLEISYS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:ANISLEISYS
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 N STATE ROAD 7 STE 110
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5715
Mailing Address - Country:US
Mailing Address - Phone:786-624-8377
Mailing Address - Fax:954-973-1882
Practice Address - Street 1:2964 N STATE ROAD 7 STE 110
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5715
Practice Address - Country:US
Practice Address - Phone:954-975-3102
Practice Address - Fax:954-973-1882
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant