Provider Demographics
NPI:1255816815
Name:LIN, QIANQIAN (AP)
Entity type:Individual
Prefix:
First Name:QIANQIAN
Middle Name:
Last Name:LIN
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 1:10616 WHITMAN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8619
Mailing Address - Country:US
Mailing Address - Phone:407-590-5945
Mailing Address - Fax:
Practice Address - Street 1:2105 HARTWOOD MARSH RD STE 9
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5390
Practice Address - Country:US
Practice Address - Phone:352-988-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty