Healthcare Provider Details

I. General information

NPI: 1043672249
Provider Name (Legal Business Name): MR. FRANK JACOB YAVOROSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ADVENTHEALTH WAY STE 210
PALM COAST FL
32137-4702
US

IV. Provider business mailing address

PO BOX 935921
ATLANTA GA
31193-5921
US

V. Phone/Fax

Practice location:
  • Phone: 386-302-1360
  • Fax: 386-302-1361
Mailing address:
  • Phone: 386-302-1360
  • Fax: 386-302-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5651
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: