Healthcare Provider Details

I. General information

NPI: 1093331985
Provider Name (Legal Business Name): CAMILA YEPES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 CONROY WINDERMERE RD
ORLANDO FL
32835-2646
US

IV. Provider business mailing address

2845 PGA BLVD
PALM BEACH GARDENS FL
33410-2910
US

V. Phone/Fax

Practice location:
  • Phone: 321-244-6799
  • Fax: 401-613-5915
Mailing address:
  • Phone: 561-693-0540
  • Fax: 561-296-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112898
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: