Individual
IVY KIM LONG PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1012 LUCERNE TER, ORLANDO, FL 32806-1015
(407) 423-1039
(407) 425-2347
Mailing address
1012 LUCERNE TER FL 1, ORLANDO, FL 32806-1015
(407) 423-1039
(407) 425-2347
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11028195
FL
Other
Enumeration date
08/16/2023
Last updated
11/21/2023
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