Provider Demographics
NPI:1831842202
Name:YOUNG, TIFFANY MONIQUE (NP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MONIQUE
Last Name: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 1:514 RIDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-2611
Mailing Address - Country:US
Mailing Address - Phone:407-300-7257
Mailing Address - Fax:
Practice Address - Street 1:555 WINDERLEY PL STE 300
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7133
Practice Address - Country:US
Practice Address - Phone:904-330-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-001448363LF0000X
FLAPRN11016257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily