Healthcare Provider Details

I. General information

NPI: 1114210945
Provider Name (Legal Business Name): ASHIK JIVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26645 MIDDLEGROUND LOOP
WESLEY CHAPEL FL
33544-1528
US

IV. Provider business mailing address

26645 MIDDLEGROUND LOOP
WESLEY CHAPEL FL
33544-1528
US

V. Phone/Fax

Practice location:
  • Phone: 813-846-3581
  • Fax:
Mailing address:
  • Phone: 813-846-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD456286
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: