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NPI Code Detail

MEDICARE: KYUWON PARK APRN

MEDICARE: KYUWON PARK APRN
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
1363L00000XNurse Practitioner11034023FL

General Provider Information

NPI Number : 1700610532
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYUWON PARK APRN
Provider Business Mailing Address
First Line : 2714 SE 30TH ST
Second Line :
City : OCALA
State : FL
Zip : 34471-0822
Country : US
Telephone Number : 352-615-3051
Fax Number :
Provider Business Practice Location Address
First Line : 3310 SW 34TH ST
Second Line :
City : OCALA
State : FL
Zip : 34474-7422
Country : US
Telephone Number : 352-873-0707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2024
Last Update Date : 02/27/2026

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Directions to “ KYUWON PARK APRN” Practice Location

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