Healthcare Provider Details

I. General information

NPI: 1700454949
Provider Name (Legal Business Name): TOMMY JACOB YARBROUGH AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 2ND AVE S # THT422
BIRMINGHAM AL
35294-0004
US

IV. Provider business mailing address

1720 2ND AVE S # THT422
BIRMINGHAM AL
35294-0004
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3411
  • Fax: 205-996-0432
Mailing address:
  • Phone: 205-572-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-149854
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-149854
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: