Individual provider Active NPI

Marissa Nicole Yanez

  • Physician Assistant
  • Tampa, FL
National Provider Identifier
1740995240
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
12807 Stanwyck Cir
Tampa, FL 33626-4466
Phone
(813) 507-8181
NPI assigned
Jan 18, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

12807 Stanwyck Cir
Tampa, FL 33626-4466

Mailing address

12807 Stanwyck Cir
Tampa, FL 33626-4466
Phone (813) 507-8181

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230317002293 FL Practitioner - Physician Assistant 2264806082 Reassigns benefits to 1 organization
I20230918000256 IL Practitioner - Physician Assistant 2264806082 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc CurrentSince Aug 26, 2024 Accepting new patients
Florida Hospital Medical Group Inc Physician Assistant CurrentSince Aug 26, 2024 Accepting new patients

Locations

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

Interoperability endpoints

  • Direct secure messaging: myanez3401792@adventhealth.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1740995240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12807 STANWYCK CIR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264466",
            "telephone_number": "813-507-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12807 STANWYCK CIR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264466",
            "telephone_number": "813-507-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANEZ",
        "first_name": "MARISSA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-18",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.