Healthcare Provider Details

I. General information

NPI: 1821587189
Provider Name (Legal Business Name): YVONNE ANDERSON BAYNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 PARK OF COMMERCE BLVD
BOCA RATON FL
33487-8218
US

IV. Provider business mailing address

6551 PARK OF COMMERCE BLVD
BOCA RATON FL
33487-8218
US

V. Phone/Fax

Practice location:
  • Phone: 561-998-8533
  • Fax:
Mailing address:
  • Phone: 561-998-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberL1-0037240
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberL1-0037240
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: