Provider Demographics
NPI:1720042625
Name:YOUNGBLOOD, JAN ELAINE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:ELAINE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1046
Mailing Address - Country:US
Mailing Address - Phone:402-598-2365
Mailing Address - Fax:
Practice Address - Street 1:11990 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2005
Practice Address - Country:US
Practice Address - Phone:402-598-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP2892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily