Healthcare Provider Details

I. General information

NPI: 1982648598
Provider Name (Legal Business Name): JODI A IRVING MS, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S. NEWELL DRIVE
GAINESVILLE FL
32611
US

IV. Provider business mailing address

PO BOX 100197
GAINESVILLE FL
32610-0197
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6367
  • Fax: 352-273-6577
Mailing address:
  • Phone: 352-273-6367
  • Fax: 352-273-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number348242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: