Provider Demographics
NPI:1518369578
Name:YOUNG, BRETT (SA-C)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12661 WESTHAMPTON CIR APT B301
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5414
Mailing Address - Country:US
Mailing Address - Phone:954-558-3920
Mailing Address - Fax:
Practice Address - Street 1:12661 WESTHAMPTON CIR APT B301
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5414
Practice Address - Country:US
Practice Address - Phone:954-558-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14-439OtherABSA CERT - SURGICAL ASSISTANT-CERTIFIED