Provider Demographics
NPI:1275218182
Name:BETANCOURT ROQUE, YOLAISY (APRN)
Entity Type:Individual
Prefix:
First Name:YOLAISY
Middle Name:
Last Name:BETANCOURT ROQUE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8316 HANLEY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2284
Mailing Address - Country:US
Mailing Address - Phone:813-964-8080
Mailing Address - Fax:
Practice Address - Street 1:8316 HANLEY RD STE 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2284
Practice Address - Country:US
Practice Address - Phone:813-964-8080
Practice Address - Fax:813-512-2733
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily