Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME62510 | FL |
Y | 207VG0400X | Gynecologist | ME62510 | FL |
NPI | 1124136742 |
---|---|
Provider Name | Janice Nicole Young |
First Address | Bonita Springs, FL 34134-7594 |
Second Address | Bonita Springs, FL 34134-7594 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 30/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25067 | BC/BS (01) | FL |
374549000 | (05) | FL |
F77288 | (02) | FL |