Healthcare Provider Details

I. General information

NPI: 1033845722
Provider Name (Legal Business Name): YANET ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N FLAGLER DR STE 680
WEST PALM BEACH FL
33401-3428
US

IV. Provider business mailing address

4074 COLT LN
WEST PALM BEACH FL
33406-2932
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone: 561-856-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: