Provider Demographics
NPI:1043672249
Name:YAVOROSKY, FRANK JACOB
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JACOB
Last Name:YAVOROSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 935921
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5921
Mailing Address - Country:US
Mailing Address - Phone:386-302-1360
Mailing Address - Fax:386-302-1361
Practice Address - Street 1:3 ADVENTHEALTH WAY STE 210
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4702
Practice Address - Country:US
Practice Address - Phone:386-302-1360
Practice Address - Fax:386-302-1361
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5651363A00000X
FLPA9116004363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant