Provider Demographics
NPI:1407574312
Name:CLYBURN, YUKINO HIGA
Entity Type:Individual
Prefix:
First Name:YUKINO
Middle Name:HIGA
Last Name:CLYBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 PINE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1714
Mailing Address - Country:US
Mailing Address - Phone:904-719-5246
Mailing Address - Fax:
Practice Address - Street 1:337 E FORSYTH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2822
Practice Address - Country:US
Practice Address - Phone:904-465-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist