Healthcare Provider Details

I. General information

NPI: 1336080456
Provider Name (Legal Business Name): YOLANDA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YOLANDA BURGOS

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

1661 WALKER ST SE
PALM BAY FL
32909-5979
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7676
  • Fax: 321-952-6179
Mailing address:
  • Phone: 786-384-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9122278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: