Healthcare Provider Details

I. General information

NPI: 1003912635
Provider Name (Legal Business Name): JEREMIE JOSEPH YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 COPPER DR
MACCLENNY FL
32063-4097
US

IV. Provider business mailing address

5970 COPPER DR
MACCLENNY FL
32063-4097
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax:
Mailing address:
  • Phone: 904-259-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number100167
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME100167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: