1023033198 NPI number — NANCY L YOUNG R MR

Table of content: NANCY L YOUNG R MR (NPI 1023033198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023033198 NPI number — NANCY L YOUNG R MR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
NANCY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R MR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023033198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 KERRY FOREST PKWY
Provider Second Line Business Mailing Address:
SUITE A1-A
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32309-6892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-894-9500
Provider Business Mailing Address Fax Number:
850-894-9501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2910 KERRY FOREST PKWY
Provider Second Line Business Practice Location Address:
SUITE A1-A
Provider Business Practice Location Address City Name:
TALLAHASSEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32309-6892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-894-9500
Provider Business Practice Location Address Fax Number:
850-894-9501
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  13117 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2471M1202X , with the licence number: 156785 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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