Healthcare Provider Details

I. General information

NPI: 1083277917
Provider Name (Legal Business Name): JENNIFER ROSE YELLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 SW 87TH WAY STE A
GAINESVILLE FL
32608-9341
US

IV. Provider business mailing address

2636 SW 35TH PL UNIT 4
GAINESVILLE FL
32608-7869
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0944
  • Fax:
Mailing address:
  • Phone: 321-297-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11001672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: