Healthcare Provider Details

I. General information

NPI: 1518444397
Provider Name (Legal Business Name): PEGAH YAGHOUBI YEGANEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12280 LAKE UNDERHILL RD
ORLANDO FL
32825-5009
US

IV. Provider business mailing address

313 BOUGIVAL CT
ORLANDO FL
32828-8223
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 321-230-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9333392
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9333392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: