Provider Demographics
NPI:1508343856
Name:YEOMANS, AMBER LEIGH (MASTERS DEGREE IN ED)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:YEOMANS
Suffix:
Gender:F
Credentials:MASTERS DEGREE IN ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 47TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-1795
Mailing Address - Country:US
Mailing Address - Phone:239-227-9015
Mailing Address - Fax:239-227-9015
Practice Address - Street 1:5432 RATTLESNAKE HAMMOCK RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7454
Practice Address - Country:US
Practice Address - Phone:239-316-7656
Practice Address - Fax:239-331-2581
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019828500Medicaid