Provider Demographics
NPI:1124801998
Name:VASQUEZ, DANIELLE MIA (FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MIA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 N LOOP 250 W STE A4
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-5743
Mailing Address - Country:US
Mailing Address - Phone:432-770-5273
Mailing Address - Fax:
Practice Address - Street 1:1307 N LOOP 250 W STE A4
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-5743
Practice Address - Country:US
Practice Address - Phone:432-770-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129354207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine