Provider Demographics
NPI:1851853741
Name:MARTIN, YANELIS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:YANELIS
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CALLE VIOLETA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6224
Mailing Address - Country:US
Mailing Address - Phone:787-525-7162
Mailing Address - Fax:
Practice Address - Street 1:80100 CALLE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6179
Practice Address - Country:US
Practice Address - Phone:787-626-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR73593Medicaid