Provider Demographics
NPI:1811172992
Name:LIU, JING
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 NW 71ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1155
Mailing Address - Country:US
Mailing Address - Phone:352-337-0551
Mailing Address - Fax:352-374-2166
Practice Address - Street 1:4635 NW 53RD AVE STE 201
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653
Practice Address - Country:US
Practice Address - Phone:352-672-6339
Practice Address - Fax:352-672-6691
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1086772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME108677OtherMEDICAL LICENSE