Provider Demographics
NPI:1376870931
Name:BORESOFF, YESENIA (PA)
Entity Type:Individual
Prefix:MISS
First Name:YESENIA
Middle Name:
Last Name:BORESOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6502
Mailing Address - Country:US
Mailing Address - Phone:727-862-6524
Mailing Address - Fax:727-862-6439
Practice Address - Street 1:7529 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6502
Practice Address - Country:US
Practice Address - Phone:727-862-6524
Practice Address - Fax:727-862-6439
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003647363AM0700X
CA20969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9107742OtherFLORIDA LICENSE NUMBER