Provider Demographics
NPI:1588944912
Name:SIMS, YVETTE LAVALLEE (ARNP)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:LAVALLEE
Last Name:SIMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:N
Other - Last Name:LAVALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1895 KINGSLEY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4453
Mailing Address - Country:US
Mailing Address - Phone:904-276-2549
Mailing Address - Fax:904-276-9235
Practice Address - Street 1:1895 KINGSLEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4453
Practice Address - Country:US
Practice Address - Phone:904-276-2549
Practice Address - Fax:904-276-9235
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9205013363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112977AMedicaid
FL004510400Medicaid
GA003112977AMedicaid
FLFJ621YMedicare PIN