Healthcare Provider Details

I. General information

NPI: 1407403538
Provider Name (Legal Business Name): YENNET LLANES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 NW 157TH LN
PEMBROKE PINES FL
33028-1536
US

IV. Provider business mailing address

565 NW 157TH LN
PEMBROKE PINES FL
33028-1536
US

V. Phone/Fax

Practice location:
  • Phone: 786-531-1595
  • Fax:
Mailing address:
  • Phone: 786-531-1595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP9394351
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9394351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: