Provider Demographics
NPI:1205069317
Name:FITZPATRICK, IVY ZO LI (DO)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:ZO LI
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:IVY
Other - Middle Name:ZO
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4674 TOWN CENTER PKWY APT 363
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8912
Mailing Address - Country:US
Mailing Address - Phone:469-810-7227
Mailing Address - Fax:
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-702-6850
Practice Address - Fax:904-702-1558
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNKNOWN207V00000X
FLOS15512207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology