Provider Demographics
NPI:1508216508
Name:YOUNG, WILLIAM (LPN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8466 LOCKWOOD RIDGE RD
Mailing Address - Street 2:#340
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2951
Mailing Address - Country:US
Mailing Address - Phone:800-939-1643
Mailing Address - Fax:
Practice Address - Street 1:10033 DOCTOR M.L.K. JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716
Practice Address - Country:US
Practice Address - Phone:800-939-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5159056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse