Provider Demographics
NPI:1780863472
Name:YOUNG, GWEN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:GWEN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 SW 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3319
Mailing Address - Country:US
Mailing Address - Phone:786-596-5942
Mailing Address - Fax:786-596-0673
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:202 EAST
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:786-596-5942
Practice Address - Fax:786-596-0673
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1152282363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health