Healthcare Provider Details

I. General information

NPI: 1265865810
Provider Name (Legal Business Name): YVONNE VIDA BOSTON MSN,ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34769-4745
US

IV. Provider business mailing address

1000 E IRLO BRONSON MEMORIAL HWY
SAINT CLOUD FL
34769-4745
US

V. Phone/Fax

Practice location:
  • Phone: 689-210-8100
  • Fax: 407-593-9413
Mailing address:
  • Phone: 407-957-0900
  • Fax: 407-593-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9244881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: