Healthcare Provider Details

I. General information

NPI: 1548015894
Provider Name (Legal Business Name): TERISA YIIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 LAKE NONA BLVD
ORLANDO FL
32827-7408
US

IV. Provider business mailing address

12567 WILLSTATTER AVE
ORLANDO FL
32827-6947
US

V. Phone/Fax

Practice location:
  • Phone: 407-266-1000
  • Fax:
Mailing address:
  • Phone: 510-386-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number060.0005942
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: