Provider Demographics
NPI:1649278318
Name:VASQUEZ, JOSE LUIS (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4024
Mailing Address - Country:US
Mailing Address - Phone:970-352-1056
Mailing Address - Fax:970-336-5000
Practice Address - Street 1:7871 S. QUEBEC STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80130-5861
Practice Address - Country:US
Practice Address - Phone:303-683-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0002658363LP0808X
CO109020363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91002761Medicaid
CO91002761Medicaid