MEDICARE: YVETTE URENA-PERALTA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F349953-01	NY
2	363LF0000X	Family Nurse Practitioner	0024189682	VA

General Provider Information

NPI Number	:	1326803107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE URENA-PERALTA FNP-BC

Provider Business Mailing Address
First Line	:	217 LAKE SIDE VIEW CT
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22406-4436
Country	:	US
Telephone Number	:	914-349-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 LAKE SIDE VIEW CT STE 1
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22406-4436
Country	:	US
Telephone Number	:	540-699-0776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	06/05/2026

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