Healthcare Provider Details

I. General information

NPI: 1104435239
Provider Name (Legal Business Name): ROBERT D YARBROUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 TOWN CENTER BLVD BLDG 400
FLEMING ISLAND FL
32003-3356
US

IV. Provider business mailing address

1845 TOWN CENTER BLVD. BLDG. 600, BOX #15
FLEMING ISLAND FL
32003
US

V. Phone/Fax

Practice location:
  • Phone: 904-529-2800
  • Fax: 904-529-2802
Mailing address:
  • Phone: 904-529-2800
  • Fax: 904-529-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008104
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: