Healthcare Provider Details

I. General information

NPI: 1699859389
Provider Name (Legal Business Name): IRLANDE KATHIA CREVECOEUR P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 S CONGRESS AVE, SUITE 304 (3C)
ATLANTIS FL
33462
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 561-766-0590
  • Fax: 561-766-0591
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: