Provider Demographics
NPI:1619221033
Name:CRITTEN-YOUNG, RENEE ANNE
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:ANNE
Last Name:CRITTEN-YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 NW 42ND DR.
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065
Mailing Address - Country:US
Mailing Address - Phone:678-949-6007
Mailing Address - Fax:770-892-5462
Practice Address - Street 1:4788 JONESBORO RD
Practice Address - Street 2:SUITE A
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291
Practice Address - Country:US
Practice Address - Phone:678-949-6007
Practice Address - Fax:770-892-5462
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 251J00000X
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care