Healthcare Provider Details

I. General information

NPI: 1275001935
Provider Name (Legal Business Name): JINGWEN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2018
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 STATE ROAD 44
NEW SMYRNA BEACH FL
32168-8341
US

IV. Provider business mailing address

4950 BAYSHORE BLVD APT 4
TAMPA FL
33611-3816
US

V. Phone/Fax

Practice location:
  • Phone: 386-428-1558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: