Provider Demographics
NPI:1447212873
Name:YOUNG, REBECCA A (CRNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 S GOLDENROD RD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8100
Mailing Address - Country:US
Mailing Address - Phone:407-672-0060
Mailing Address - Fax:407-672-0440
Practice Address - Street 1:733 S GOLDENROD RD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8100
Practice Address - Country:US
Practice Address - Phone:407-672-0060
Practice Address - Fax:407-672-0440
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9358333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49611Medicare UPIN
MD723LH504Medicare ID - Type Unspecified