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General NPI Number Information
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NPI Number | 1083556674
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Entity Type | Individual
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Provider Name | DUSTY TYLER YOUNG
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Gender | Male
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 100 N MAIN ST
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City | CHATTAHOOCHEE
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State | FL
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Zip | 32324-1107
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Country | US
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Telephone | 850-663-1046
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 SEABS RD
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City | TALLAHASSEE
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State | FL
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Zip | 32310-1234
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9575583
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License Number State | FL
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