Provider Demographics
NPI:1194029892
Name:AHN, JIN (ARNP)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W UNDERWOOD ST
Mailing Address - Street 2:MP 80
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:888-912-3648
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:86 W UNDERWOOD ST
Practice Address - Street 2:MP 80
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:888-912-3648
Practice Address - Fax:321-841-4085
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9306734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003418200Medicaid
FLARNP9306734OtherMEDICAL LICENSE
FLARNP9306734OtherMEDICAL LICENSE