Individual
IVY WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1150 N 35TH AVE STE 540, HOLLYWOOD, FL 33021-5431
(954) 265-2750
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112611
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112192000
—
FL
Enumeration date
07/02/2021
Last updated
11/20/2023
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