Provider Demographics
NPI:1457835027
Name:MARRERO LEREBOURS, YANSEL
Entity Type:Individual
Prefix:
First Name:YANSEL
Middle Name:
Last Name:MARRERO LEREBOURS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8834 BEACON LAKES DR APT 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3490
Mailing Address - Country:US
Mailing Address - Phone:787-525-7432
Mailing Address - Fax:
Practice Address - Street 1:8834 BEACON LAKES DR APT 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3490
Practice Address - Country:US
Practice Address - Phone:787-525-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9479334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily