Provider Demographics
NPI:1043052590
Name:FAN, YUN (NP)
Entity type:Individual
Prefix:
First Name:YUN
Middle Name:
Last Name:FAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 CEDAR CHASE CV
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9065
Mailing Address - Country:US
Mailing Address - Phone:646-577-5291
Mailing Address - Fax:
Practice Address - Street 1:11325 LAKE UNDERHILL RD STE 102
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5090
Practice Address - Country:US
Practice Address - Phone:407-275-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily