Provider Demographics
NPI:1356371579
Name:LO, LIYUAN (CRNA)
Entity type:Individual
Prefix:
First Name:LIYUAN
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LI
Other - Middle Name:MARY
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:SUITE A327
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-4396
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:SUITE A327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-844-4396
Practice Address - Fax:813-844-4972
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC069434367500000X
FLARNP 9287849367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered