Provider Demographics
NPI:1821216789
Name:LI, QINGRONG (AP)
Entity Type:Individual
Prefix:
First Name:QINGRONG
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 S HERCULES AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6313
Mailing Address - Country:US
Mailing Address - Phone:727-441-8680
Mailing Address - Fax:
Practice Address - Street 1:575 S HERCULES AVE STE 601
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6313
Practice Address - Country:US
Practice Address - Phone:727-441-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1216171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist