1679004998 NPI number — DANIELLE YOUNG

Table of content: DANIELLE YOUNG (NPI 1679004998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679004998 NPI number — DANIELLE YOUNG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1679004998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 PRUDENTIAL DR STE 1130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32207-8331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-633-4199
Provider Business Mailing Address Fax Number:
904-633-4188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 PRUDENTIAL DR STE 1130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-633-4199
Provider Business Practice Location Address Fax Number:
904-633-4188
Provider Enumeration Date:
03/27/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 107126800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com