Provider Demographics
NPI:1134694466
Name:STAFFORD, YOLANDA EVETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:EVETTE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N HOGAN ST # 320
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4201
Mailing Address - Country:US
Mailing Address - Phone:912-464-2998
Mailing Address - Fax:
Practice Address - Street 1:221 N HOGAN ST # 320
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4201
Practice Address - Country:US
Practice Address - Phone:912-464-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9326363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily