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General NPI Number Information
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NPI Number | 1407163314
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Entity Type | Individual
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Provider Name | AMANDA F YOUNG PROVIDER
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Gender | Female
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 8335 MORNING GLORY RD N
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4588
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Country | US
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Telephone | 904-378-8374
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Fax | 904-378-8374
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Provider Business Mailing Address
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Address Line | 8335 MORNING GLORY RD N
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4588
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Country | US
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Telephone | 904-378-8374
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Fax | 904-378-8374
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 686761896
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 686761898
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 002084700
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License Number State | FL
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