Healthcare Provider Details

I. General information

NPI: 1417763400
Provider Name (Legal Business Name): DR. YALITZA VARGAS-FELICIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S US HIGHWAY 17 STE A&B
EAST PALATKA FL
32131-6071
US

IV. Provider business mailing address

106 SOUTH AVE
BROCKPORT NY
14420-2012
US

V. Phone/Fax

Practice location:
  • Phone: 386-312-0250
  • Fax:
Mailing address:
  • Phone: 787-209-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPACN53
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1905-PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: