Provider Demographics
NPI:1235597279
Name:VINCENT, YVENA (NP)
Entity Type:Individual
Prefix:
First Name:YVENA
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:YVENA
Other - Middle Name:
Other - Last Name:SAINT LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5230 SUWANEE DAM RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1722
Mailing Address - Country:US
Mailing Address - Phone:404-388-0883
Mailing Address - Fax:
Practice Address - Street 1:5230 SUWANEE DAM RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1722
Practice Address - Country:US
Practice Address - Phone:404-388-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA191038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily