Provider Demographics
NPI:1780659185
Name:IVANCOVA, XENIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:XENIE
Middle Name:
Last Name:IVANCOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-5489
Mailing Address - Country:US
Mailing Address - Phone:407-665-3212
Mailing Address - Fax:
Practice Address - Street 1:400 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-5489
Practice Address - Country:US
Practice Address - Phone:407-665-3341
Practice Address - Fax:407-665-3213
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039272300Medicaid
FL039272300Medicaid
FL53584TMedicare PIN