MEDICARE: DONTAVIA TANIAH YANCEY CNA,MEDICAL TECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	19120176	FL

General Provider Information

NPI Number	:	1235099292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONTAVIA TANIAH YANCEY CNA,MEDICAL TECH

Provider Business Mailing Address
First Line	:	209 W 18TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2818
Country	:	US
Telephone Number	:	904-333-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 W 18TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-2818
Country	:	US
Telephone Number	:	305-504-5690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	01/06/2026

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