Provider Demographics
NPI:1669625836
Name:CHIN-YOUNG, VICTORIA VINCELLA (NP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:VINCELLA
Last Name:CHIN-YOUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 INDIAN TRL RD NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1721
Mailing Address - Country:US
Mailing Address - Phone:470-545-2131
Mailing Address - Fax:
Practice Address - Street 1:950 INDIAN TRAIL LILBURN RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1721
Practice Address - Country:US
Practice Address - Phone:470-545-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604593-1163W00000X
GARN265573363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse