Healthcare Provider Details

I. General information

NPI: 1588829550
Provider Name (Legal Business Name): MS. DENISE IRISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 TRUMPWORTH CT
VALRICO FL
33596-8494
US

IV. Provider business mailing address

P.O. BOX 673
VALRICO FL
33594
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-4745
  • Fax: 813-685-4745
Mailing address:
  • Phone: 813-685-4745
  • Fax: 813-685-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: