Healthcare Provider Details

I. General information

NPI: 1194347997
Provider Name (Legal Business Name): CESELLY LAYNE YATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E REDSTONE AVE
CRESTVIEW FL
32539-5373
US

IV. Provider business mailing address

PO BOX 11037
PENSACOLA FL
32524-1037
US

V. Phone/Fax

Practice location:
  • Phone: 850-444-7004
  • Fax: 850-444-7497
Mailing address:
  • Phone: 850-444-4700
  • Fax: 850-444-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11006628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: