1407925126 NPI number — JACQUELINE G YORK P.A.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407925126 NPI number — JACQUELINE G YORK P.A.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

YORK

Provider First Name:

JACQUELINE

Provider Middle Name:

G

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

P.A.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1407925126

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/29/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 30532

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PENSACOLA

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

32503-1532

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

850-916-3700

Provider Business Mailing Address Fax Number:

850-916-3710

Provider First Line Business Practice Location Address:

1040 GULF BREEZE PKWY

Provider Second Line Business Practice Location Address:

SUITE 200

Provider Business Practice Location Address City Name:

GULF BREEZE

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32561-7809

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

850-916-3700

Provider Business Practice Location Address Fax Number:

850-916-3710

Provider Enumeration Date:

11/07/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363A00000X , with the licence number:  PA9100693 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 59197952 . This is a "BCBS ALABAMA - DH2" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 121498 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 59197954 . This is a "BCBS - SX" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: P00222818 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: E2224Z . This is a "BCBS FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 290827100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
• Identifier: 59010138 . This is a "BCBS ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 121495 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: Y00MR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 593-05287 . This is a "BCBS ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 593-05288 . This is a "BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 014151500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".