Provider Demographics
NPI:1083265516
Name:JEAN-MARC, YVA (NP-C)
Entity Type:Individual
Prefix:
First Name:YVA
Middle Name:
Last Name:JEAN-MARC
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2487 S GILBERT RD STE 106-132
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2804
Mailing Address - Country:US
Mailing Address - Phone:813-965-3044
Mailing Address - Fax:
Practice Address - Street 1:22707 S ELLSWORTH RD STE H101
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7568
Practice Address - Country:US
Practice Address - Phone:480-792-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07190632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty