Provider Demographics
NPI:1811389869
Name:YOUNG, SHANTE NICOLE (DNP)
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:SHANTE
Other - Middle Name:NICOLE
Other - Last Name:TUMBLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 CARRIAGE OAKS DR # 1020
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1684
Mailing Address - Country:US
Mailing Address - Phone:678-250-6123
Mailing Address - Fax:551-214-0934
Practice Address - Street 1:1668 MULKEY RD STE H
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1163
Practice Address - Country:US
Practice Address - Phone:678-250-6123
Practice Address - Fax:551-214-0934
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192017363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care