Provider Demographics
NPI:1932665916
Name:VAZQUEZ, NANNY
Entity Type:Individual
Prefix:
First Name:NANNY
Middle Name:
Last Name:VAZQUEZ
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 1:2190 PAINTER LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7819
Mailing Address - Country:US
Mailing Address - Phone:407-489-3568
Mailing Address - Fax:
Practice Address - Street 1:1006 PLAZA DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-4069
Practice Address - Country:US
Practice Address - Phone:407-927-1437
Practice Address - Fax:407-910-4768
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health