Provider Demographics
NPI:1306963046
Name:YOUNG, MICHELE KATHERINE (ARNP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:KATHERINE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:KATHERINE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:3402 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6214
Practice Address - Country:US
Practice Address - Phone:813-875-3950
Practice Address - Fax:813-872-2741
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3083942363LG0600X
FLAPRN3083942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110605800Medicaid