MEDICARE: DR. JOSEPHINE BATISTA YATCO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME0089068	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0089068	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568467637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPHINE BATISTA YATCO M.D.

Provider Business Mailing Address
First Line	:	1463 NECTARINE ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3027
Country	:	US
Telephone Number	:	904-491-0177
Fax Number	:	904-491-3173

Provider Business Practice Location Address
First Line	:	13453 N MAIN ST STE 503
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-2774
Country	:	US
Telephone Number	:	904-491-0177
Fax Number	:	904-491-3173

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/19/2015

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