Healthcare Provider Details

I. General information

NPI: 1821906694
Provider Name (Legal Business Name): NING LI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12196 YEW TREE RD
JACKSONVILLE FL
32218-1699
US

IV. Provider business mailing address

12196 YEW TREE RD
JACKSONVILLE FL
32218-1699
US

V. Phone/Fax

Practice location:
  • Phone: 626-776-0109
  • Fax:
Mailing address:
  • Phone: 626-776-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number109988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: