Provider Demographics
NPI:1619584315
Name:MAIS, YANIQUE L (APRN/CNM)
Entity Type:Individual
Prefix:
First Name:YANIQUE
Middle Name:L
Last Name:MAIS
Suffix:
Gender:F
Credentials:APRN/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 1/2 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2227
Mailing Address - Country:US
Mailing Address - Phone:754-226-7814
Mailing Address - Fax:
Practice Address - Street 1:3621 1/2 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33405-2227
Practice Address - Country:US
Practice Address - Phone:754-226-7814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty