Provider Demographics
NPI:1376009159
Name:JESUCA, YVENET (NP)
Entity Type:Individual
Prefix:
First Name:YVENET
Middle Name:
Last Name:JESUCA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21820 CYPRESS CIR APT 25B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3215
Mailing Address - Country:US
Mailing Address - Phone:561-674-4554
Mailing Address - Fax:
Practice Address - Street 1:21820 CYPRESS CIR APT 25B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3215
Practice Address - Country:US
Practice Address - Phone:561-674-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9332110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily