Provider Demographics
NPI:1457729881
Name:VASQUEZ, JENNIFER ROSE (NP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ROSE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 E SINTON ST
Mailing Address - Street 2:
Mailing Address - City:SINTON
Mailing Address - State:TX
Mailing Address - Zip Code:78387-2928
Mailing Address - Country:US
Mailing Address - Phone:361-364-2804
Mailing Address - Fax:361-364-5014
Practice Address - Street 1:1143 E SINTON ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2928
Practice Address - Country:US
Practice Address - Phone:361-364-2804
Practice Address - Fax:361-364-5014
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily