Provider Demographics
NPI:1588408264
Name:YOUNG, MADISON MARIE (PA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 HOLLOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7896
Mailing Address - Country:US
Mailing Address - Phone:239-771-5173
Mailing Address - Fax:
Practice Address - Street 1:5151 WINTER GARDEN VINELAND RD STE 201
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6098
Practice Address - Country:US
Practice Address - Phone:321-842-4766
Practice Address - Fax:321-842-9360
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118342363A00000X
FLPA9118342363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant