Fan, Qing Ivy

Fan, Qing Ivy is an individual health care provider with primary practice located at 6817 Southpoint Pkwy #503, Jacksonville FL 32216-6282. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Fan, Qing Ivy can be contacted via phone (904) 296-9777.

Contact Information

Primary practice address
6817 Southpoint Pkwy #503 Jacksonville FL 32216-6282
Fax: (904) 296-9977
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 0000040237 Tennessee

Profile Details

NPI number 1679520365
LBN Legal business name Fan, Qing Ivy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 28th, 2006
Last updated Sep 18th, 2008 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679520365 NPPES
Florida MEDICAID 404037
Florida MEDICAID 3336593

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