MEDICARE: YAN YAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	44714	FL

General Provider Information

NPI Number	:	1518896547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAN YAN

Provider Business Mailing Address
First Line	:	489 ELM CREEK DR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-3548
Country	:	US
Telephone Number	:	813-570-9094
Fax Number	:

Provider Business Practice Location Address
First Line	:	4421 SUN N LAKE BLVD STE B
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-2172
Country	:	US
Telephone Number	:	863-402-3130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/18/2026

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Directions to “ YAN YAN ” Practice Location

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