Provider Demographics
NPI:1710034806
Name:VENERACION-YUMUL, ANNA-MARIE MALAZARTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA-MARIE
Middle Name:MALAZARTE
Last Name:VENERACION-YUMUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:VENERACION
Other - Last Name:YUMUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1118 GREEN PINE CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2567
Mailing Address - Country:US
Mailing Address - Phone:904-282-8079
Mailing Address - Fax:
Practice Address - Street 1:1409 KINGSLEY AVE
Practice Address - Street 2:STE 9E
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4537
Practice Address - Country:US
Practice Address - Phone:904-215-4151
Practice Address - Fax:904-215-4165
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME928192084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272990300Medicaid
FL2600109465852OtherTAX ID #
FL272990300Medicaid