Healthcare Provider Details

I. General information

NPI: 1922516632
Provider Name (Legal Business Name): YANICK MAXENA RENEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 W STATE ROAD 84 STE 206
DAVIE FL
33324-4235
US

IV. Provider business mailing address

2756 NW 1ST CT
POMPANO BEACH FL
33069-2501
US

V. Phone/Fax

Practice location:
  • Phone: 954-634-3636
  • Fax: 954-634-3637
Mailing address:
  • Phone: 954-627-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: