Provider Demographics
NPI:1285391144
Name:YOUNETIC LLC
Entity type:Organization
Organization Name:YOUNETIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-268-7990
Mailing Address - Street 1:122 E MAIN ST STE 186
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4655
Mailing Address - Country:US
Mailing Address - Phone:863-268-7990
Mailing Address - Fax:863-204-0648
Practice Address - Street 1:122 E MAIN ST STE 186
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4655
Practice Address - Country:US
Practice Address - Phone:863-268-7990
Practice Address - Fax:863-204-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-25
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty