Provider Demographics
NPI:1386682680
Name:YOUNG, CARLTON QUINT (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:QUINT
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32347-1502
Mailing Address - Country:US
Mailing Address - Phone:850-838-2629
Mailing Address - Fax:850-838-2140
Practice Address - Street 1:1211 N CENTER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347-2037
Practice Address - Country:US
Practice Address - Phone:850-838-2141
Practice Address - Fax:850-838-2140
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant