Provider Demographics
NPI:1942739974
Name:ELIAS, YENNISSE
Entity Type:Individual
Prefix:
First Name:YENNISSE
Middle Name:
Last Name:ELIAS
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 1:702 RACHNA LN APT C702
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2861
Mailing Address - Country:US
Mailing Address - Phone:407-963-6845
Mailing Address - Fax:863-540-2549
Practice Address - Street 1:702 RACHNA LN APT C702
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2861
Practice Address - Country:US
Practice Address - Phone:407-963-6845
Practice Address - Fax:863-540-2549
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE423960655500343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)