Healthcare Provider Details

I. General information

NPI: 1811389869
Provider Name (Legal Business Name): SHANTE NICOLE YOUNG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANTE NICOLE TUMBLING DNP, FNP-C, PMHNP-BC

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 NEWNAN CROSSING BLVD E
NEWNAN GA
30265-1517
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-5854
  • Fax:
Mailing address:
  • Phone:
  • Fax: 551-214-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN192017
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN192017
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN192017
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: