Healthcare Provider Details

I. General information

NPI: 1659857555
Provider Name (Legal Business Name): DANE J YOUTZ ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 N HESPERIDES ST
TAMPA FL
33614-5414
US

IV. Provider business mailing address

442 W KENNEDY BLVD STE 280
TAMPA FL
33606-1464
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-6111
  • Fax: 813-906-1755
Mailing address:
  • Phone: 813-467-6111
  • Fax: 813-906-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.414914
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.023064
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11010471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: