Healthcare Provider Details

I. General information

NPI: 1427232107
Provider Name (Legal Business Name): IRA M WALTER MSN-ED, APRN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 CREW CIR APT 5
MELBOURNE FL
32904-8440
US

IV. Provider business mailing address

4652 CREW CIR APT 5
MELBOURNE FL
32904-8440
US

V. Phone/Fax

Practice location:
  • Phone: 321-462-9522
  • Fax:
Mailing address:
  • Phone: 321-462-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number602855
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9290651
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11013625
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: