Provider Demographics
NPI:1962025197
Name:HSIA, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:HSIA
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 1:1570 ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7453
Mailing Address - Country:US
Mailing Address - Phone:904-264-1204
Mailing Address - Fax:904-308-6890
Practice Address - Street 1:1570 ISLAND LN
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7453
Practice Address - Country:US
Practice Address - Phone:904-264-1204
Practice Address - Fax:904-308-6890
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008617363A00000X
FLPA9120945363A00000X
IL085.008617363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL432105532Medicaid