Healthcare Provider Details

I. General information

NPI: 1053613117
Provider Name (Legal Business Name): BARBARA IRIZARRY-LUKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3127 W. HALLANDALE BEACH BLVD. SUITE 115
PEMBROKE PARK FL
33009
US

IV. Provider business mailing address

2006 N.46TH AVE
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 754-816-3071
  • Fax: 754-816-3077
Mailing address:
  • Phone: 954-534-5773
  • Fax: 754-816-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9212291
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN9212291
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9212291
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN9212291
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN9212291
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9212291
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN9212291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: