Provider Demographics
NPI:1275978124
Name:THYBULLE, MARIE YVES LAURENCE
Entity Type:Individual
Prefix:
First Name:MARIE YVES LAURENCE
Middle Name:
Last Name:THYBULLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8408 TRENT CT APT C
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8511
Mailing Address - Country:US
Mailing Address - Phone:954-709-0860
Mailing Address - Fax:
Practice Address - Street 1:612 ANDERSON CIR APT 110
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-7743
Practice Address - Country:US
Practice Address - Phone:954-709-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9345643163W00000X
FLAPRN11009685363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse