Healthcare Provider Details

I. General information

NPI: 1083033351
Provider Name (Legal Business Name): JASMINE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE RD STE 200
LUTZ FL
33558-8005
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-6237
  • Fax: 813-463-1801
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME136431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: