Provider Demographics
NPI:1750871216
Name:YASIN, SOPHIA SHEHEREZADE (ARNP)
Entity type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:SHEHEREZADE
Last Name:YASIN
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:WINDERMERE #1350
Mailing Address - Street 2:2831 MAGUIRE RD.
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6057
Mailing Address - Country:US
Mailing Address - Phone:407-654-0568
Mailing Address - Fax:
Practice Address - Street 1:WINDERMERE #1350
Practice Address - Street 2:2831 MAGUIRE RD.
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6057
Practice Address - Country:US
Practice Address - Phone:407-654-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9367908363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMY5249429OtherDEA