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General NPI Number Information
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NPI Number | 1942682984
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Entity Type | Individual
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Provider Name | STACY LYNN YOUNG MSN, APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 901 STERTHAUS DR
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5133
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Country | US
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Telephone | 573-552-6866
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Fax |
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Provider Business Mailing Address
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Address Line | 25 CANTERBURY WOODS
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2449
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Country | US
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Telephone | 573-552-6866
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11024636
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2015016930
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License Number State | MO
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