Provider Demographics
NPI:1811645005
Name:FERNANDEZ TUR, YENNISSE
Entity type:Individual
Prefix:
First Name:YENNISSE
Middle Name:
Last Name:FERNANDEZ TUR
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 1:5809 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3310
Mailing Address - Country:US
Mailing Address - Phone:786-378-2618
Mailing Address - Fax:
Practice Address - Street 1:5809 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3310
Practice Address - Country:US
Practice Address - Phone:786-378-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-119348106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician