Provider Demographics
NPI:1427743509
Name:VASQUEZ, ALEXI DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXI
Middle Name:DANIELLE
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXI
Other - Middle Name:DANIELLE
Other - Last Name:BIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2727 AZALEA AVE APT 2322
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-1925
Mailing Address - Country:US
Mailing Address - Phone:972-569-7438
Mailing Address - Fax:
Practice Address - Street 1:2727 AZALEA AVE APT 2322
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-1925
Practice Address - Country:US
Practice Address - Phone:972-569-7438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant