Healthcare Provider Details

I. General information

NPI: 1013515824
Provider Name (Legal Business Name): YAZMIN YOSHELLIN CERVANTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 M.L.K. JR WAY
TACOMA WA
98405
US

IV. Provider business mailing address

8719 59TH ST W
UNIVERSITY PLACE WA
98467-1647
US

V. Phone/Fax

Practice location:
  • Phone: 253-280-2205
  • Fax:
Mailing address:
  • Phone: 253-441-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN60025395
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP61124296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: