Healthcare Provider Details

I. General information

NPI: 1942195524
Provider Name (Legal Business Name): SHELLEY YOUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

V. Phone/Fax

Practice location:
  • Phone: 386-623-3044
  • Fax:
Mailing address:
  • Phone: 352-265-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: