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General NPI Number Information
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NPI Number | 1851753594
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Entity Type | Individual
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Provider Name | JAVIER IBARRA APRN FNP-C
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 845 W CRAIG RD STE 104
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-0282
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Country | US
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Telephone | 702-326-4756
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Fax |
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Provider Business Mailing Address
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Address Line | 845 W CRAIG RD STE 104
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-0282
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Country | US
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Telephone | 702-740-0648
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Fax | 702-740-0655
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN002132
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License Number State | NV
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