Provider Demographics
NPI:1285228999
Name:KHAYKIN, YULI JOHANNA (CNP)
Entity Type:Individual
Prefix:
First Name:YULI
Middle Name:JOHANNA
Last Name:KHAYKIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHACKLE WAY APT 145
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1224
Mailing Address - Country:US
Mailing Address - Phone:781-913-3980
Mailing Address - Fax:
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD STE 630
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6399
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-738-9008
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2314264363LW0102X
FLAPRN11019757363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11019757OtherMEDICAL LICENSE