Provider Demographics
NPI:1568467637
Name:YATCO, JOSEPHINE BATISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:BATISTA
Last Name:YATCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 NECTARINE ST
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3027
Mailing Address - Country:US
Mailing Address - Phone:904-491-0177
Mailing Address - Fax:904-491-3173
Practice Address - Street 1:13453 N MAIN ST STE 503
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2774
Practice Address - Country:US
Practice Address - Phone:904-491-0177
Practice Address - Fax:904-491-3173
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0089068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271710700Medicaid
FL0089068OtherMEDICAL LICENSE
FL0089068OtherMEDICAL LICENSE