Provider Demographics
NPI:1700668860
Name:FONTAINE, YVESNERSON (APRN MSN FNP-BC)
Entity type:Individual
Prefix:MR
First Name:YVESNERSON
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:M
Credentials:APRN MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7081 ENVIRON BLVD APT 542
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4270
Mailing Address - Country:US
Mailing Address - Phone:786-370-9612
Mailing Address - Fax:
Practice Address - Street 1:6264 W SAMPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3273
Practice Address - Country:US
Practice Address - Phone:954-837-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022176363L00000X
FLRN9439283163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse