Provider Demographics
NPI:1366234106
Name:THOMPSON YOUNG, MARCELETE LATANYA (MSN, APRN, AGPCNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARCELETE
Middle Name:LATANYA
Last Name:THOMPSON YOUNG
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-1921
Mailing Address - Country:US
Mailing Address - Phone:850-766-0007
Mailing Address - Fax:
Practice Address - Street 1:2034 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-1921
Practice Address - Country:US
Practice Address - Phone:850-766-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9235833163W00000X
FLAPRN11039342363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse