Healthcare Provider Details

I. General information

NPI: 1346060738
Provider Name (Legal Business Name): YOLAYDA ROQUE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YOLAYDA MARTINEZ MARTINEZ

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N PARSONS AVE
BRANDON FL
33510-4538
US

IV. Provider business mailing address

1007 COASTAL HAMMOCK AVE FL 33570
RUSKIN FL
33570-2205
US

V. Phone/Fax

Practice location:
  • Phone: 813-505-8467
  • Fax:
Mailing address:
  • Phone: 813-505-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11035873
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberAPRN11035873
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberAPRN11035873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: