MEDICARE: CHRISTINA WANG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	9110835	FL
2	363AS0400X	Surgical Physician Assistant	PA9110835	FL

General Provider Information

NPI Number	:	1952812273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA WANG PA-C

Provider Business Mailing Address
First Line	:	3000 BAYVIEW DR STE 100
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1772
Country	:	US
Telephone Number	:	954-567-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 BAYVIEW DR STE 100
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1772
Country	:	US
Telephone Number	:	954-567-1332
Fax Number	:	954-537-2721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	04/14/2022

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