Provider Demographics
NPI:1932678802
Name:TABRAUE, YENNY
Entity Type:Individual
Prefix:
First Name:YENNY
Middle Name:
Last Name:TABRAUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 NW 13TH AVE APT 1231
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5736
Mailing Address - Country:US
Mailing Address - Phone:786-499-8946
Mailing Address - Fax:
Practice Address - Street 1:185 NW 13TH AVE APT 1231
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5736
Practice Address - Country:US
Practice Address - Phone:786-499-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9429998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner