Healthcare Provider Details

I. General information

NPI: 1710633987
Provider Name (Legal Business Name): LIGUO ZHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 SW 148TH AVE UNIT1409
SUNRISE FL
33325
US

IV. Provider business mailing address

785 SW 148TH AVE UNIT1409
SUNRISE FL
33325
US

V. Phone/Fax

Practice location:
  • Phone: 408-858-0890
  • Fax:
Mailing address:
  • Phone: 408-858-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11032876
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9445180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: