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General NPI Number Information
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NPI Number | 1356195911
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Entity Type | Individual
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Provider Name | CHI VAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 4620 N 22ND ST
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City | TAMPA
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State | FL
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Zip | 33610-6205
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Country | US
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Telephone | 813-397-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 N 22ND ST
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City | TAMPA
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State | FL
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Zip | 33610-6205
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Country | US
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Telephone | 813-397-5300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9118692
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License Number State | FL
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