Healthcare Provider Details

I. General information

NPI: 1851853741
Provider Name (Legal Business Name): YANELIS MARTIN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80100 CALLE FERNANDEZ JUNCOS
CAROLINA PR
00985-6179
US

IV. Provider business mailing address

232 CALLE VIOLETA
SAN JUAN PR
00927-6224
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-0472
  • Fax:
Mailing address:
  • Phone: 787-525-7162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3422
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: