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General NPI Number Information
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NPI Number | 1891343661
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Entity Type | Individual
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Provider Name | IVETH MASTRAPA
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 3727 N GOLDENROD RD STE 106
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City | WINTER PARK
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State | FL
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Zip | 32792-8611
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Country | US
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Telephone | 407-478-0028
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Fax | 321-203-4720
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Provider Business Mailing Address
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Address Line | 16662 CORNER LAKE DR
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City | ORLANDO
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State | FL
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Zip | 32820-1928
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Country | US
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Telephone | 321-948-6122
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 11003642
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11003642
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 11003642
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 11003642
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 11003642
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11003642
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License Number State | FL
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