Healthcare Provider Details

I. General information

NPI: 1104145622
Provider Name (Legal Business Name): JOSHUA MARK YEYKAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 KINGSLEY AVE STE 1900
ORANGE PARK FL
32073-4451
US

IV. Provider business mailing address

1548 ANSLEY PL
ST JOHNS FL
32259-5208
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-2549
  • Fax:
Mailing address:
  • Phone: 814-860-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS16261
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS16261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: