Healthcare Provider Details

I. General information

NPI: 1255280400
Provider Name (Legal Business Name): YVELINE MANOUCHKA OSIAS ANTOINE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-4353
US

IV. Provider business mailing address

1329 WINTER GARDEN VINELAND RD
WINTER GARDEN FL
34787-4353
US

V. Phone/Fax

Practice location:
  • Phone: 407-879-8676
  • Fax:
Mailing address:
  • Phone: 689-300-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025111201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: