Healthcare Provider Details

I. General information

NPI: 1609659606
Provider Name (Legal Business Name): BING LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 10/10/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 S BELCHER RD
CLEARWATER FL
33764-2829
US

IV. Provider business mailing address

6811 NICOLE LN
LARGO FL
33771-4774
US

V. Phone/Fax

Practice location:
  • Phone: 727-524-4464
  • Fax: 727-538-7272
Mailing address:
  • Phone: 727-248-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11028009
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: