Healthcare Provider Details

I. General information

NPI: 1871028647
Provider Name (Legal Business Name): KRYSTLE RENEE IRIZARRY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRYSTLE RENEE IRIZARRY KRYSTLE MORRIS

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 WEKIVA COMMONS CIR
APOPKA FL
32712-3645
US

IV. Provider business mailing address

515 WEKIVA COMMONS CIR
APOPKA FL
32712-3645
US

V. Phone/Fax

Practice location:
  • Phone: 407-464-9516
  • Fax: 407-464-9519
Mailing address:
  • Phone: 407-464-9516
  • Fax: 407-464-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO22718
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS15671
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS15671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: