Healthcare Provider Details

I. General information

NPI: 1861757734
Provider Name (Legal Business Name): MICHELE LYNN YOUNG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL STE A140
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

5513 NEW INDEPENDENCE PKWY
WINTER GARDEN FL
34787-8783
US

V. Phone/Fax

Practice location:
  • Phone: 407-821-3620
  • Fax:
Mailing address:
  • Phone: 740-649-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107366
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9107366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: