Provider Demographics
NPI:1407163314
Name:YOUNG, AMANDA F (PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:F
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:G
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PROVIDER
Mailing Address - Street 1:8335 MORNING GLORY RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4588
Mailing Address - Country:US
Mailing Address - Phone:904-378-8374
Mailing Address - Fax:904-378-8374
Practice Address - Street 1:8335 MORNING GLORY RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4588
Practice Address - Country:US
Practice Address - Phone:904-378-8374
Practice Address - Fax:904-378-8374
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL686761896171W00000X
FL686761898171W00000X
FL002084700171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor