Provider Demographics
NPI:1215952064
Name:YARBROUGH, SYLVIA LYN (PA-C)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:LYN
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:904-354-6868
Mailing Address - Fax:904-358-3067
Practice Address - Street 1:155 BARTRAM MARKET DR STE 120
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-4582
Practice Address - Country:US
Practice Address - Phone:904-650-2193
Practice Address - Fax:904-201-6350
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101191363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292219300Medicaid