Provider Demographics
NPI:1114618626
Name:YOUNG, QUINCY SUZANNE (PA)
Entity Type:Individual
Prefix:
First Name:QUINCY
Middle Name:SUZANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 W FRYE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6184
Mailing Address - Country:US
Mailing Address - Phone:480-917-5600
Mailing Address - Fax:602-294-8292
Practice Address - Street 1:1875 W FRYE RD STE 300
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6184
Practice Address - Country:US
Practice Address - Phone:480-917-5600
Practice Address - Fax:602-294-8292
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9711363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant