Provider Demographics
NPI:1295240372
Name:VAZQUEZ, TATIANA
Entity type:Individual
Prefix:
First Name:TATIANA
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 1:7831 REFLECTION COVE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-6584
Mailing Address - Country:US
Mailing Address - Phone:239-564-0114
Mailing Address - Fax:
Practice Address - Street 1:7831 REFLECTION COVE DR APT 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-6584
Practice Address - Country:US
Practice Address - Phone:239-564-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other