Provider Demographics
NPI:1427047968
Name:YOUNG-HENLEY, TEMUKISA TONYA (MD)
Entity type:Individual
Prefix:
First Name:TEMUKISA
Middle Name:TONYA
Last Name:YOUNG-HENLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 S US HIGHWAY 17/92 STE 144
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2259
Mailing Address - Country:US
Mailing Address - Phone:407-636-8580
Mailing Address - Fax:407-636-8581
Practice Address - Street 1:7800 S US HIGHWAY 17/92 STE 144
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2259
Practice Address - Country:US
Practice Address - Phone:407-636-8580
Practice Address - Fax:407-636-8581
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263732400Medicaid
FL263732400Medicaid
FLH58505Medicare UPIN