Healthcare Provider Details

I. General information

NPI: 1497086185
Provider Name (Legal Business Name): JORGE ANTONIO REYES YAQUIAN MD, IMH, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 45TH ST
WEST PALM BEACH FL
33407-2047
US

IV. Provider business mailing address

1631 LAKEFIELD NORTH CT
WELLINGTON FL
33414-1066
US

V. Phone/Fax

Practice location:
  • Phone: 772-248-2291
  • Fax: 772-248-2298
Mailing address:
  • Phone: 772-248-2291
  • Fax: 722-248-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023019153
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9509651
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH 7890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: