Provider Demographics
NPI:1679509558
Name:YOUNG, SANDRA W (MSN, ARNP, BC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSN, ARNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW 10TH AVE
Mailing Address - Street 2:DOMINION TOWER, #813A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1000
Mailing Address - Country:US
Mailing Address - Phone:305-243-4598
Mailing Address - Fax:305-243-4037
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:BOX 016960 M851
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-4664
Practice Address - Fax:305-243-8470
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1231282363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3049779-00Medicaid
FL3049779-00Medicaid
FLE8850Medicare ID - Type Unspecified