Healthcare Provider Details

I. General information

NPI: 1215456322
Provider Name (Legal Business Name): YANISLEIDY ACEA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 OLD COUNTRY RD
RIVERHEAD NY
11901-3146
US

IV. Provider business mailing address

2826 NW 7TH ST
CAPE CORAL FL
33993-6438
US

V. Phone/Fax

Practice location:
  • Phone: 239-245-2522
  • Fax:
Mailing address:
  • Phone: 239-245-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: