Healthcare Provider Details

I. General information

NPI: 1417837980
Provider Name (Legal Business Name): AHAD SALIM JIVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SW 2ND AVE
OCALA FL
34471-0926
US

IV. Provider business mailing address

1040 SW 2ND AVE
OCALA FL
34471-0926
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-3005
  • Fax: 352-732-8977
Mailing address:
  • Phone: 352-732-3005
  • Fax: 352-732-8977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11042031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: