Provider Demographics
NPI:1194180703
Name:YOUR HEALTH NURSE PRACTITIONER
Entity Type:Organization
Organization Name:YOUR HEALTH NURSE PRACTITIONER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:GERMEIL
Authorized Official - Last Name:BALDEOSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-318-6885
Mailing Address - Street 1:2060 GREENVIEW SHORES BLVD
Mailing Address - Street 2:APT 315
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2731
Mailing Address - Country:US
Mailing Address - Phone:561-452-8563
Mailing Address - Fax:561-318-6885
Practice Address - Street 1:2060 GREENVIEW SHORES BLVD
Practice Address - Street 2:APT 315
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2731
Practice Address - Country:US
Practice Address - Phone:561-452-8563
Practice Address - Fax:561-318-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9182389261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0012166-00Medicaid
FL1578712220OtherNPI
FL0012166-00Medicaid