MEDICARE: YUAN TIAN APRN

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	363LA2100X	Acute Care Nurse Practitioner	APRN11028163	FL
2	363L00000X	Nurse Practitioner	APRN11028163	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982480414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUAN TIAN APRN

Provider Business Mailing Address
First Line	:	2041 BANNER LN
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1820
Country	:	US
Telephone Number	:	786-525-1859
Fax Number	:

Provider Business Practice Location Address
First Line	:	4359 HUNTERS PARK LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7614
Country	:	US
Telephone Number	:	407-251-6511
Fax Number	:	407-251-6513

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

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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Directions to “ YUAN TIAN APRN” Practice Location

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