Provider Demographics
NPI:1184427981
Name:YOUNG, JACKLYN MONIQUE
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:MONIQUE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 WILSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2833
Mailing Address - Country:US
Mailing Address - Phone:516-356-6087
Mailing Address - Fax:
Practice Address - Street 1:930 WILSON BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2833
Practice Address - Country:US
Practice Address - Phone:516-356-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY881767-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse