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General NPI Number Information
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NPI Number | 1881134831
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Entity Type | Individual
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Provider Name | ABBY POLLICK YAGODA PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 4275 WESTERN BLVD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-1100
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Country | US
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Telephone | 910-938-3099
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Fax | 910-938-3243
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | POLLOCKSVILLE
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State | NC
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Zip | 28573-0068
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Country | US
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Telephone | 910-938-3099
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Fax | 910-938-3243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-08791
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA058887
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License Number State | PA
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