Healthcare Provider Details

I. General information

NPI: 1114358538
Provider Name (Legal Business Name): IRINA LYTVYN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11528 US HIGHWAY 19
PORT RICHEY FL
34668-1442
US

IV. Provider business mailing address

11528 US HIGHWAY 19
PORT RICHEY FL
34668-1442
US

V. Phone/Fax

Practice location:
  • Phone: 278-682-1517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9329931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: