Provider Demographics
NPI:1083306062
Name:FERRUS-ESPINOZA, YVES-LISE JESSICA (PA)
Entity Type:Individual
Prefix:
First Name:YVES-LISE
Middle Name:JESSICA
Last Name:FERRUS-ESPINOZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 AUTUMN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1511
Mailing Address - Country:US
Mailing Address - Phone:929-319-9528
Mailing Address - Fax:
Practice Address - Street 1:69 AUTUMN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1511
Practice Address - Country:US
Practice Address - Phone:929-319-9528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant