Provider Demographics
NPI:1184323230
Name:VASQUEZ, MARCIE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:MARIE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BEDFORD FALLS LN
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-0630
Mailing Address - Country:US
Mailing Address - Phone:956-561-1057
Mailing Address - Fax:
Practice Address - Street 1:1313 N STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-5613
Practice Address - Country:US
Practice Address - Phone:254-346-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1049310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily