Healthcare Provider Details

I. General information

NPI: 1093815854
Provider Name (Legal Business Name): EVA MICHELLE YACOBI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

IV. Provider business mailing address

855 S HIGHLAND AVE
CLEARWATER FL
33756-4446
US

V. Phone/Fax

Practice location:
  • Phone: 727-219-1833
  • Fax: 727-330-2908
Mailing address:
  • Phone: 727-219-1833
  • Fax: 727-330-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME84991
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: