Healthcare Provider Details

I. General information

NPI: 1134004385
Provider Name (Legal Business Name): JEFF ANDREW BALDO YEPEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N CAUSEWAY STE A
NEW SMYRNA BEACH FL
32169-5328
US

IV. Provider business mailing address

2522 GOLDEN PARK LN
TALLAHASSEE FL
32303-3687
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-1584
  • Fax:
Mailing address:
  • Phone: 850-559-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11039434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: