Healthcare Provider Details

I. General information

NPI: 1760947303
Provider Name (Legal Business Name): MIRANDA YOUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/20/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E CHEVES ST
FLORENCE SC
29506-2710
US

IV. Provider business mailing address

700 SAINT GEORGE DR
FLORENCE SC
29505-3638
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-0122
  • Fax:
Mailing address:
  • Phone: 803-900-0983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number30011
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: