Provider Demographics
NPI:1124136742
Name:YOUNG, JANICE NICOLE (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PIPER BLVD STE 21
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1385
Mailing Address - Country:US
Mailing Address - Phone:239-591-3311
Mailing Address - Fax:239-591-3327
Practice Address - Street 1:1201 PIPER BLVD STE 21
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1385
Practice Address - Country:US
Practice Address - Phone:239-591-3311
Practice Address - Fax:239-591-3327
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62510207VF0040X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374549000Medicaid
FL25067OtherBC/BS
FLF77288Medicare UPIN
FL374549000Medicaid
FL374549000Medicaid