Basic Information
| Provider Information | |||||||||
| NPI: | 1093815854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YACOBI | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 S HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337564446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272191833 | ||||||||
| FaxNumber: | 7273302908 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 S HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337564446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272191833 | ||||||||
| FaxNumber: | 7273302908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME84991 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 004854000 | 05 | FL | MEDICAID | 286709 | 01 | FL | AVMED | OTHER | 7789407 | 01 | FL | AETNA | OTHER | WBKF6 | 01 | FL | FLORIDA BLUE | OTHER |