Provider Demographics
NPI:1558192013
Name:NEWKIRK, YOLANDA REVE
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:REVE
Last Name:NEWKIRK
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 1:4460 FOWLER ST STE 8
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-2617
Mailing Address - Country:US
Mailing Address - Phone:239-895-6172
Mailing Address - Fax:
Practice Address - Street 1:4460 FOWLER ST STE 8
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-2617
Practice Address - Country:US
Practice Address - Phone:239-895-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL1252574335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier