MEDICARE: DIANN YOUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1659826873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANN YOUNG

Provider Business Mailing Address
First Line	:	3759 FAIRVIEW COVE LN APT 302
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-3761
Country	:	US
Telephone Number	:	813-239-7866
Fax Number	:

Provider Business Practice Location Address
First Line	:	3759 FAIRVIEW COVE LN APT 302
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-3761
Country	:	US
Telephone Number	:	813-239-7866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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Directions to “ DIANN YOUNG ” Practice Location

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