Provider Demographics
NPI:1447615570
Name:LEE, JAE YOUNG (RN)
Entity Type:Individual
Prefix:
First Name:JAE YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:JAE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6500 W NEWBERRY RD
Mailing Address - Street 2:CARDIOVASCULAR UNIT
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4309
Mailing Address - Country:US
Mailing Address - Phone:352-333-5521
Mailing Address - Fax:
Practice Address - Street 1:6500 W NEWBERRY RD
Practice Address - Street 2:CARDIOVASCULAR UNIT
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4309
Practice Address - Country:US
Practice Address - Phone:352-333-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9348578163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine