Provider Demographics
NPI:1417763400
Name:VARGAS-FELICIANO, YALITZA
Entity type:Individual
Prefix:DR
First Name:YALITZA
Middle Name:
Last Name:VARGAS-FELICIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-2012
Mailing Address - Country:US
Mailing Address - Phone:787-209-3384
Mailing Address - Fax:
Practice Address - Street 1:199 S US HIGHWAY 17 STE A&B
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131-6071
Practice Address - Country:US
Practice Address - Phone:386-312-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1905-PA363AM0700X
FLPACN53363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical