Provider Demographics
NPI:1689143422
Name:YOUNGBLOOD, SHARISSA (APRN)
Entity Type:Individual
Prefix:
First Name:SHARISSA
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6586 HYPOLUXO RD STE 334
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:877-412-7272
Mailing Address - Fax:
Practice Address - Street 1:6080 BOYNTON BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3586
Practice Address - Country:US
Practice Address - Phone:877-412-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000257363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care