Provider Demographics
NPI:1073091500
Name:LLOYD, YANIQUE
Entity Type:Individual
Prefix:
First Name:YANIQUE
Middle Name:
Last Name:LLOYD
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 1:10103 COUNT FLEET DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6772
Mailing Address - Country:US
Mailing Address - Phone:813-540-7800
Mailing Address - Fax:
Practice Address - Street 1:10103 COUNT FLEET DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6772
Practice Address - Country:US
Practice Address - Phone:813-540-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235091251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL235091OtherAHCA