Healthcare Provider Details

I. General information

NPI: 1982454807
Provider Name (Legal Business Name): HAN LI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1101
US

IV. Provider business mailing address

4835 RAGGEDY POINT RD
ORANGE PARK FL
32003-7847
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0655
  • Fax:
Mailing address:
  • Phone: 405-613-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number41499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: