Healthcare Provider Details

I. General information

NPI: 1457835027
Provider Name (Legal Business Name): YANSEL MARRERO LEREBOURS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CENTER RD
VENICE FL
34285-5572
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 833-674-2500
  • Fax:
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9479334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: