Provider Demographics
NPI:1689405516
Name:YACAVONE, BROOKE ALEXIS
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXIS
Last Name:YACAVONE
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 1:7031 WUERPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2349
Mailing Address - Country:US
Mailing Address - Phone:504-655-4361
Mailing Address - Fax:
Practice Address - Street 1:5646 READ BLVD STE 380
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3148
Practice Address - Country:US
Practice Address - Phone:504-518-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA342695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant