Healthcare Provider Details

I. General information

NPI: 1073348611
Provider Name (Legal Business Name): YALI N/A CUERIA SOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 OLD ACOSTA RD
JACKSONVILLE FL
32223-4902
US

IV. Provider business mailing address

3165 OLD ACOSTA RD
JACKSONVILLE FL
32223-4902
US

V. Phone/Fax

Practice location:
  • Phone: 904-323-8042
  • Fax:
Mailing address:
  • Phone: 904-323-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: