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General NPI Number Information
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NPI Number | 1134952757
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Entity Type | Organization
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Legal Business Name | GRECIA S IBARRA APRN LLC
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 8407 PINEHURST DR STE 104
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City | TAMPA
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State | FL
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Zip | 33615-1532
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Country | US
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Telephone | 813-850-0050
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Fax | 813-308-5500
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Provider Business Mailing Address
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Address Line | 19119 DOVE RD
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City | LAND O LAKES
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State | FL
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Zip | 34638-2592
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Country | US
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Telephone | 813-850-0050
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Fax | 813-308-5500
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Authorized Official
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Title or Position | OWNER
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Name | GRECIA SOFIA IBARRA
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Credential | APRN
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Telephone | 813-850-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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