Provider Demographics
NPI:1417619339
Name:FERMIN NINA, YEYVY ANTHONY (APRN)
Entity Type:Individual
Prefix:
First Name:YEYVY
Middle Name:ANTHONY
Last Name:FERMIN NINA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 KIRTLEY DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2253
Mailing Address - Country:US
Mailing Address - Phone:813-808-5401
Mailing Address - Fax:
Practice Address - Street 1:1520 KIRTLEY DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2253
Practice Address - Country:US
Practice Address - Phone:813-808-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5350367Medicaid