1710092879 NPI number — MS. DENISE ANN STILES-YOUNT RPH

Table of content: MS. DENISE ANN STILES-YOUNT RPH (NPI 1710092879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710092879 NPI number — MS. DENISE ANN STILES-YOUNT RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILES-YOUNT
Provider First Name:
DENISE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1710092879
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:
12875 RABBIT RUN LN
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:
32246-1077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-221-3147
Provider Business Mailing Address Fax Number:
904-723-2671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6022 ATLANTIC BLVD
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:
32211-7503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-725-1616
Provider Business Practice Location Address Fax Number:
904-723-2671
Provider Enumeration Date:
08/20/2006

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: 183500000X , with the licence number:  19852 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FL19852 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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