Healthcare Provider Details

I. General information

NPI: 1568467637
Provider Name (Legal Business Name): JOSEPHINE BATISTA YATCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13453 N MAIN ST STE 503
JACKSONVILLE FL
32218-2774
US

IV. Provider business mailing address

1463 NECTARINE ST
FERNANDINA BEACH FL
32034-3027
US

V. Phone/Fax

Practice location:
  • Phone: 904-491-0177
  • Fax: 904-491-3173
Mailing address:
  • Phone: 904-491-0177
  • Fax: 904-491-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0089068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: