Healthcare Provider Details

I. General information

NPI: 1962245100
Provider Name (Legal Business Name): TORI YOUNG AGNP-C, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 41ST ST
WILMINGTON NC
28403-5502
US

IV. Provider business mailing address

2334 41ST ST
WILMINGTON NC
28403-5502
US

V. Phone/Fax

Practice location:
  • Phone: 844-854-6884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number306329
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5022706
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5022706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: