MEDICARE: INGRY T VO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN9293975	FL
2	363LF0000X	Family Nurse Practitioner	APRN9293975	FL
3	363L00000X	Nurse Practitioner	95020491	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780178392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRY T VO APRN

Provider Business Mailing Address
First Line	:	PO BOX 81064
Second Line	:
City	:	RANCHO SANTA MARGARITA
State	:	CA
Zip	:	92688-8164
Country	:	US
Telephone Number	:	772-618-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2237 W BALL RD
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-5314
Country	:	US
Telephone Number	:	714-490-2750
Fax Number	:	714-490-2757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	06/16/2026

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