Healthcare Provider Details

I. General information

NPI: 1083265516
Provider Name (Legal Business Name): YVA JEAN-MARC NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6952 E BROADWAY RD
MESA AZ
85208-1974
US

IV. Provider business mailing address

2487 S GILBERT RD STE 106-132
GILBERT AZ
85295-2804
US

V. Phone/Fax

Practice location:
  • Phone: 480-325-0906
  • Fax: 480-325-6661
Mailing address:
  • Phone: 813-965-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number07190632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: