Healthcare Provider Details

I. General information

NPI: 1700640463
Provider Name (Legal Business Name): ADRIANA IANCU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 11TH AVENUE CIR E
BRADENTON FL
34208-5885
US

IV. Provider business mailing address

3300 N TRIUMPH BLVD STE 500
LEHI UT
84043-6475
US

V. Phone/Fax

Practice location:
  • Phone: 716-220-5411
  • Fax:
Mailing address:
  • Phone: 801-821-2333
  • Fax: 801-901-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11024499
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: