Healthcare Provider Details

I. General information

NPI: 1215039870
Provider Name (Legal Business Name): QIXIA HUANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 102A
ST AUGUSTINE FL
32080-3109
US

IV. Provider business mailing address

1301 PLANTATION ISLAND DR S STE 102A
ST AUGUSTINE FL
32080-3109
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-5626
  • Fax: 904-461-8796
Mailing address:
  • Phone: 904-471-5626
  • Fax: 904-461-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME78764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: