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General NPI Number Information
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NPI Number | 1508416389
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Entity Type | Organization
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Legal Business Name | THOMAS P YOUNG PHD NP PC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 165 ROWLAND WAY STE 201
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City | NOVATO
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State | CA
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Zip | 94945-5055
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Country | US
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Telephone | 415-895-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 1615 HILL RD STE 14
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City | NOVATO
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State | CA
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Zip | 94947-4304
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Country | US
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Telephone | 415-895-1441
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Fax | 415-895-1288
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS P YOUNG III
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Credential | PHD NP
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Telephone | 415-755-8952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State |
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