Provider Demographics
NPI:1760861538
Name:YOUNG, JILL ALLISON (CNM)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ALLISON
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 IMPERIAL BLVD STE B2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4689
Mailing Address - Country:US
Mailing Address - Phone:813-684-2229
Mailing Address - Fax:813-413-8507
Practice Address - Street 1:1525 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3203
Practice Address - Country:US
Practice Address - Phone:863-284-6860
Practice Address - Fax:863-688-7959
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9181902367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015014000Medicaid
FLARNP9181902OtherSTATE LICENSE