Healthcare Provider Details

I. General information

NPI: 1073275186
Provider Name (Legal Business Name): LILIANA MARIA YEPES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 CHARLIE SMITH SR HWY STE F
SAINT MARYS GA
31558-2833
US

IV. Provider business mailing address

4468 ORTEGA FOREST DR
JACKSONVILLE FL
32210-5819
US

V. Phone/Fax

Practice location:
  • Phone: 904-877-1887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11015612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: