Provider Demographics
NPI:1225001415
Name:YOUNG, CONSTANCE ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15902 NW 120TH PL
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-6676
Mailing Address - Country:US
Mailing Address - Phone:386-462-9535
Mailing Address - Fax:
Practice Address - Street 1:1326 STATE RD 100
Practice Address - Street 2:
Practice Address - City:GRANDIN
Practice Address - State:FL
Practice Address - Zip Code:32138-0129
Practice Address - Country:US
Practice Address - Phone:386-659-2104
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3301802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3301802OtherARNP LICENSE NUMBER
FLY088FOtherBC/BS NUMBER