Provider Demographics
NPI:1669100608
Name:EXANTUS, PIERRE MARIE YANICK (PA)
Entity type:Individual
Prefix:DR
First Name:PIERRE MARIE
Middle Name:YANICK
Last Name:EXANTUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7194
Mailing Address - Country:US
Mailing Address - Phone:954-479-9653
Mailing Address - Fax:
Practice Address - Street 1:140 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7194
Practice Address - Country:US
Practice Address - Phone:954-479-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical