Provider Demographics
NPI:1568114239
Name:TABUCHI, YOLANDA E (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:E
Last Name:TABUCHI
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12829 BAYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0787
Mailing Address - Country:US
Mailing Address - Phone:140-779-7878
Mailing Address - Fax:
Practice Address - Street 1:12829 BAYSTONE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0787
Practice Address - Country:US
Practice Address - Phone:407-797-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL680622896171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator