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General NPI Number Information
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NPI Number | 1235837774
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Entity Type | Individual
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Provider Name | MR. SCOTT DOUGLAS IVY
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Gender | Male
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Dates
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Enumeration Date | 02/22/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 11004 ROCKLEDGE VIEW DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-2370
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Country | US
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Telephone | 813-531-2383
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Fax | 813-922-0223
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Provider Business Mailing Address
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Address Line | 11004 ROCKLEDGE VIEW DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-2370
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Country | US
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Telephone | 813-531-2383
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Fax | 813-922-0223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | FL
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