Healthcare Provider Details

I. General information

NPI: 1518896547
Provider Name (Legal Business Name): YAN YAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 SUN N LAKE BLVD STE B
SEBRING FL
33872-2172
US

IV. Provider business mailing address

489 ELM CREEK DR
SAINT AUGUSTINE FL
32092-3548
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3763
  • Fax:
Mailing address:
  • Phone: 813-570-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: