Provider Demographics
NPI:1366993305
Name:YOUNG, CARRIE MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 W 55TH ST
Mailing Address - Street 2:APT 10F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4913
Mailing Address - Country:US
Mailing Address - Phone:602-684-9655
Mailing Address - Fax:
Practice Address - Street 1:10111 TARPON DR
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-3122
Practice Address - Country:US
Practice Address - Phone:602-684-9655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ141974163W00000X
CA700754163W00000X
NJ26NR18625800163W00000X
NY22-600514163W00000X
FLAPRN11002237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse