Provider Demographics
NPI:1679979538
Name:REDWAN VAZQUEZ, SUHAM TRINIDAD (RN)
Entity type:Individual
Prefix:MRS
First Name:SUHAM
Middle Name:TRINIDAD
Last Name:REDWAN VAZQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 66TH ST W
Mailing Address - Street 2:APT 300A
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2632
Mailing Address - Country:US
Mailing Address - Phone:305-799-0099
Mailing Address - Fax:
Practice Address - Street 1:4601 66TH ST W
Practice Address - Street 2:APT 300A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2632
Practice Address - Country:US
Practice Address - Phone:305-799-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9213587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse