Healthcare Provider Details

I. General information

NPI: 1649567876
Provider Name (Legal Business Name): JOSEPH T YOUNG P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6685 NW 9TH BLVD
GAINESVILLE FL
32605-4206
US

IV. Provider business mailing address

6716 NW 11TH PL
GAINESVILLE FL
32605-4215
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-7847
  • Fax: 352-333-0900
Mailing address:
  • Phone: 352-331-9729
  • Fax: 352-331-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAT9106049
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: