MEDICARE: MR. YVESNERSON FONTAINE APRN MSN 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	363L00000X	Nurse Practitioner	APRN11022176	FL
2	163W00000X	Registered Nurse	RN9439283	FL

General Provider Information

NPI Number	:	1700668860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YVESNERSON FONTAINE APRN MSN FNP-BC

Provider Business Mailing Address
First Line	:	7081 ENVIRON BLVD APT 542
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-4270
Country	:	US
Telephone Number	:	786-370-9612
Fax Number	:

Provider Business Practice Location Address
First Line	:	6264 W SAMPLE RD STE 100
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3273
Country	:	US
Telephone Number	:	954-837-1010
Fax Number	:

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

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/13/2023

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