1801442470 NPI number — DR. JESSICA DENISSE VAZQUEZ DNP, CRNP, FNP-BC

Table of content: DR. JESSICA DENISSE VAZQUEZ DNP, CRNP, FNP-BC (NPI 1801442470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801442470 NPI number — DR. JESSICA DENISSE VAZQUEZ DNP, CRNP, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAZQUEZ
Provider First Name:
JESSICA
Provider Middle Name:
DENISSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, CRNP, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801442470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6528 MARSDEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19135-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-997-9853
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 W GIRARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-440-9547
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP-020660 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com