Provider Demographics
NPI:1356918627
Name:FUX KAHN, IVANNA (PA-C)
Entity type:Individual
Prefix:
First Name:IVANNA
Middle Name:
Last Name:FUX KAHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85033 MAJESTIC WALK BLVD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3871
Mailing Address - Country:US
Mailing Address - Phone:858-775-5652
Mailing Address - Fax:
Practice Address - Street 1:216 WINDY WOODS WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8419
Practice Address - Country:US
Practice Address - Phone:910-264-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9120030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty