Healthcare Provider Details

I. General information

NPI: 1831842202
Provider Name (Legal Business Name): TIFFANY MONIQUE YOUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WINDERLEY PL STE 300
MAITLAND FL
32751-7133
US

IV. Provider business mailing address

514 RIDGEWOOD ST
ALTAMONTE SPRINGS FL
32701-2611
US

V. Phone/Fax

Practice location:
  • Phone: 904-330-1024
  • Fax:
Mailing address:
  • Phone: 407-300-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-001448
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: