Provider Demographics
NPI:1861573891
Name:VASQUEZ, TANA RENAE (ARNP)
Entity type:Individual
Prefix:MS
First Name:TANA
Middle Name:RENAE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2050
Mailing Address - Country:US
Mailing Address - Phone:850-232-6587
Mailing Address - Fax:
Practice Address - Street 1:BLDG 94043 NORTH CLARK ROAD
Practice Address - Street 2:RUSSELL COLLIER HEALTH CARE CLINIC
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-3014
Practice Address - Fax:254-553-3119
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776835363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics