Healthcare Provider Details

I. General information

NPI: 1255628640
Provider Name (Legal Business Name): PENG LI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/21/2022
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # 100275
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD # 100275
GAINESVILLE FL
32610-0301
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7839
  • Fax: 352-273-8172
Mailing address:
  • Phone: 352-273-7839
  • Fax: 352-273-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME132726
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME132726
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number8437499-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: