Provider Demographics
NPI:1548967565
Name:VAZQUEZ, NATHANIEL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6907 N CAPITAL OF TEXAS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1710
Mailing Address - Country:US
Mailing Address - Phone:512-735-4567
Mailing Address - Fax:
Practice Address - Street 1:6907 N CAPITAL OF TEXAS HWY STE 240
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1710
Practice Address - Country:US
Practice Address - Phone:512-458-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087529363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care