Provider Demographics
NPI:1023548484
Name:MCCAIN, PEARL YVETTE
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:YVETTE
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5307
Mailing Address - Country:US
Mailing Address - Phone:321-632-2737
Mailing Address - Fax:321-637-1963
Practice Address - Street 1:4085 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5307
Practice Address - Country:US
Practice Address - Phone:321-632-2737
Practice Address - Fax:321-637-1963
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator