Provider Demographics
NPI:1518740851
Name:HERRERA VAZQUEZ, DIANELYS (DIANELYS HERRERA)
Entity type:Individual
Prefix:
First Name:DIANELYS
Middle Name:
Last Name:HERRERA VAZQUEZ
Suffix:
Gender:F
Credentials:DIANELYS HERRERA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14502 N DALE MABRY HWY STE 328
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2043
Mailing Address - Country:US
Mailing Address - Phone:813-440-6490
Mailing Address - Fax:
Practice Address - Street 1:14502 N DALE MABRY HWY STE 328
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2043
Practice Address - Country:US
Practice Address - Phone:813-440-6490
Practice Address - Fax:305-671-3505
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily