Healthcare Provider Details

I. General information

NPI: 1770477283
Provider Name (Legal Business Name): YOKO LOUISE YOUNGMAN MS, RDN, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 1/2 12TH AVE N
ST PETERSBURG FL
33701-1737
US

IV. Provider business mailing address

209 1/2 12TH AVE N
ST PETERSBURG FL
33701-1737
US

V. Phone/Fax

Practice location:
  • Phone: 727-258-1906
  • Fax:
Mailing address:
  • Phone: 727-258-1906
  • Fax: 727-258-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86145762
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number14379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: