Provider Demographics
NPI:1033803804
Name:SEGARRA, YACHIRA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:YACHIRA
Middle Name:MARIE
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4891 LAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-3680
Mailing Address - Country:US
Mailing Address - Phone:808-428-6496
Mailing Address - Fax:
Practice Address - Street 1:4891 LAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-3680
Practice Address - Country:US
Practice Address - Phone:808-428-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5253036164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse