Provider Demographics
NPI:1467109652
Name:PENA, YANERIS (NP)
Entity Type:Individual
Prefix:
First Name:YANERIS
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MASON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3111
Mailing Address - Country:US
Mailing Address - Phone:978-652-6289
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-436-9060
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner