Provider Demographics
NPI:1154773695
Name:GOLUBEVA, YELENA (NP)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:GOLUBEVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9013 BEACON MANOR TER
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-6300
Mailing Address - Country:US
Mailing Address - Phone:917-692-2245
Mailing Address - Fax:
Practice Address - Street 1:9013 BEACON MANOR TER
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-6300
Practice Address - Country:US
Practice Address - Phone:917-692-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9428530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily