Provider Demographics
NPI:1740995240
Name:YANEZ, MARISSA NICOLE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:NICOLE
Last Name:YANEZ
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 1:12807 STANWYCK CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4466
Mailing Address - Country:US
Mailing Address - Phone:813-507-8181
Mailing Address - Fax:
Practice Address - Street 1:12807 STANWYCK CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4466
Practice Address - Country:US
Practice Address - Phone:813-507-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant