Healthcare Provider Details

I. General information

NPI: 1629435169
Provider Name (Legal Business Name): YADIRIS CZERNIAK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 BALM RIVERVIEW RD
RIVERVIEW FL
33569-5107
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2528
  • Fax: 407-303-2760
Mailing address:
  • Phone: 484-628-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP015873
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11033769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: