Provider Demographics
NPI:1184980617
Name:PANGANIBAN, DESIREE VASQUEZ (ARNP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:VASQUEZ
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11111 HERON BAY BLVD
Mailing Address - Street 2:APT 4822
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8409 N MILITARY TRL
Practice Address - Street 2:SUITE 126
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-296-9200
Practice Address - Fax:561-296-9215
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9267967363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health