Basic Information
| Provider Information | |||||||||
| NPI: | 1093748204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMBLIN | ||||||||
| FirstName: | YOLAINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10280 PINES BLVD STE P701 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330266057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543238446 | ||||||||
| FaxNumber: | 9543238207 | ||||||||
| Practice Location | |||||||||
| Address1: | 10280 PINES BLVD STE P701 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330266057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543238446 | ||||||||
| FaxNumber: | 9543238207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME88893 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | U2485D | 01 | FL | MEDICARE ID | OTHER | 2699943500 | 05 | FL | MEDICAID |