Provider Demographics
NPI:1942071048
Name:YOST, PRISCILLA MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:MARIE
Last Name:YOST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 VIRGINIA DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4156
Mailing Address - Country:US
Mailing Address - Phone:850-586-1258
Mailing Address - Fax:
Practice Address - Street 1:134 VIRGINIA DR NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4156
Practice Address - Country:US
Practice Address - Phone:850-586-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FL9118313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant