Provider Demographics
NPI:1245479005
Name:ARISTHYL, YAJAIDA (ARNP)
Entity type:Individual
Prefix:
First Name:YAJAIDA
Middle Name:
Last Name:ARISTHYL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 S CLEVELAND AVE STE 15A
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1371
Mailing Address - Country:US
Mailing Address - Phone:239-689-7411
Mailing Address - Fax:239-766-7753
Practice Address - Street 1:4650 S CLEVELAND AVE STE 15A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1371
Practice Address - Country:US
Practice Address - Phone:239-689-7411
Practice Address - Fax:239-766-7753
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9241385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCD086WMedicare PIN
FLCD086ZMedicare PIN
FLCD086YMedicare PIN