Provider Demographics
NPI:1801076732
Name:YOUNG, JENNIFER NANCY (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NANCY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NANCY
Other - Last Name:HEFFERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4100 SALZEDO ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1751
Mailing Address - Country:US
Mailing Address - Phone:786-227-6811
Mailing Address - Fax:
Practice Address - Street 1:4100 SALZEDO ST STE 4
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1751
Practice Address - Country:US
Practice Address - Phone:786-227-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0677207R00000X
VA0101274089207R00000X, 207R00000X
SC87445207R00000X
IN01087564A207R00000X
NC2022-01645207R00000X
MO2022007449207R00000X
ORMD202494207R00000X
MN68642207R00000X
WAMD61126080207R00000X
CAA96715207R00000X
WI74858-20207R00000X
MA291431207R00000X
CODR.0065680207R00000X
FLME 125964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine