1912196841 NPI number — MID-FLORIDA INFECTIOUS DISEASE, PA

Table of content: VICTORIA MARIE YOUNG LPC (NPI 1295264638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912196841 NPI number — MID-FLORIDA INFECTIOUS DISEASE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MID-FLORIDA INFECTIOUS DISEASE, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912196841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 568863
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32856-8863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-894-6618
Provider Business Mailing Address Fax Number:
407-894-6619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 PATTERSON RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
HAINES CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33844-6261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-422-8123
Provider Business Practice Location Address Fax Number:
863-422-8725
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-894-6618

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  ME69417 , 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)





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