Healthcare Provider Details

I. General information

NPI: 1003404369
Provider Name (Legal Business Name): YAMELL MARTIN PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 DEL PRADO BLVD S
CAPE CORAL FL
33990-4615
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-8880
  • Fax: 239-574-4876
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11010813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: