Healthcare Provider Details

I. General information

NPI: 1609546928
Provider Name (Legal Business Name): YANELLE YLIANA OLMOS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 RANCH ROAD 620 N STE 101
AUSTIN TX
78750-1141
US

IV. Provider business mailing address

8802 NORTH PATH
AUSTIN TX
78759-7224
US

V. Phone/Fax

Practice location:
  • Phone: 512-593-6022
  • Fax:
Mailing address:
  • Phone: 915-543-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1040439
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: