Provider Demographics
NPI:1811389869
Name:YOUNG, SHANTE NICOLE (DNP)
Entity type:Individual
Prefix:
First Name:SHANTE
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:SHANTE
Other - Middle Name:NICOLE
Other - Last Name:TUMBLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:551-214-0934
Practice Address - Street 1:1751 NEWNAN CROSSING BLVD E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1517
Practice Address - Country:US
Practice Address - Phone:678-423-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192017363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care