Provider Demographics
NPI:1396883690
Name:YOUNG, JOHN F JR (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 W DELEON ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-353-0023
Mailing Address - Fax:
Practice Address - Street 1:2835 W DELEON ST
Practice Address - Street 2:UNIT 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-353-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO151188367500000X
ARC02740367500000X
FLARNP 9312707367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR83490OtherARK BLUE SHIELD
MO175118OtherMO BLUE SHIELD
AR159252001Medicaid
MO917205809Medicaid
MO826723268Medicare PIN
AR5V121Medicare PIN