Provider Demographics
NPI:1275944696
Name:AGOSTINI, YARA C (ARNP)
Entity Type:Individual
Prefix:
First Name:YARA
Middle Name:C
Last Name:AGOSTINI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:YARA
Other - Middle Name:C
Other - Last Name:GOCKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:30 RAEMOND LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6855
Mailing Address - Country:US
Mailing Address - Phone:386-503-8407
Mailing Address - Fax:
Practice Address - Street 1:298 S YONGE ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6264
Practice Address - Country:US
Practice Address - Phone:386-278-7800
Practice Address - Fax:386-274-7801
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9259871363LC0200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner