Healthcare Provider Details

I. General information

NPI: 1659188431
Provider Name (Legal Business Name): YU WANG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W HIGHWAY 50 STE 104
CLERMONT FL
34711-2982
US

IV. Provider business mailing address

PO BOX 162
GOTHA FL
34734-0162
US

V. Phone/Fax

Practice location:
  • Phone: 689-349-8700
  • Fax: 689-689-6093
Mailing address:
  • Phone: 689-349-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11036188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: