Provider Demographics
NPI:1689743288
Name:MIGNON, YVETTE (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:MIGNON
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 1:1965 CAPITAL CIRCLE, NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8401
Mailing Address - Country:US
Mailing Address - Phone:850-656-2006
Mailing Address - Fax:850-656-2820
Practice Address - Street 1:1965 CAPITAL CIRCLE, NE
Practice Address - Street 2:SUITE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8401
Practice Address - Country:US
Practice Address - Phone:850-656-2006
Practice Address - Fax:850-656-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266402000Medicaid
FL266402000Medicaid
FLH85216Medicare UPIN