Healthcare Provider Details

I. General information

NPI: 1396434510
Provider Name (Legal Business Name): BRANDON YOUNG APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST
BALTIMORE MD
21225-1233
US

IV. Provider business mailing address

5730 FERNLEY DR E APT 24
WEST PALM BEACH FL
33415-8322
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-3200
  • Fax:
Mailing address:
  • Phone: 954-851-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11019407
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11019407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: