Individual
KRISTEN NICOLE VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
519 STEPHENSON AVE, SAVANNAH, GA 31405-5969
(912) 354-9447
(912) 401-0741
Mailing address
519 STEPHENSON AVE, SAVANNAH, GA 31405-5969
(912) 354-9447
(912) 401-0741
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
005581
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0859PA
—
SC
05
—
350511798C
—
GA
05
—
350511798D
—
GA
01
—
P00778518
RR MEDICARE
GA
01
—
PA9110541
LICENSE
FL
Enumeration date
05/20/2009
Last updated
10/27/2020
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