Healthcare Provider Details

I. General information

NPI: 1528016375
Provider Name (Legal Business Name): YVONNE JURCIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JFK DR
ATLANTIS FL
33462-6608
US

IV. Provider business mailing address

5700 LAKE WORTH RD # 204
GREENACRES FL
33463-4727
US

V. Phone/Fax

Practice location:
  • Phone: 561-968-6767
  • Fax: 561-641-0814
Mailing address:
  • Phone: 561-968-7968
  • Fax: 561-964-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number36-3478105
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME99589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: