Provider Demographics
NPI:1053168559
Name:VAZQUEZ, MARCELLA (APRN)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 INTERSTATE WAY NW
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9701
Mailing Address - Country:US
Mailing Address - Phone:863-633-9686
Mailing Address - Fax:
Practice Address - Street 1:5901 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2117
Practice Address - Country:US
Practice Address - Phone:863-471-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028182363LF0000X
FL11028182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily