Provider Demographics
NPI:1841229572
Name:YAKUBU, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:YAKUBU
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 1:11464 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2216
Mailing Address - Country:US
Mailing Address - Phone:813-914-7772
Mailing Address - Fax:813-914-0014
Practice Address - Street 1:10320 N 56TH ST STE 210
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-4057
Practice Address - Country:US
Practice Address - Phone:813-914-7772
Practice Address - Fax:813-914-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58843208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064738101Medicaid