Healthcare Provider Details

I. General information

NPI: 1962025197
Provider Name (Legal Business Name): YVONNE HSIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 ISLAND LN
FLEMING ISLAND FL
32003-7453
US

IV. Provider business mailing address

1570 ISLAND LN
FLEMING ISLAND FL
32003-7453
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-1204
  • Fax: 904-308-6890
Mailing address:
  • Phone: 904-264-1204
  • Fax: 904-308-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008617
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120945
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.008617
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: