MEDICARE: GABRIELA IBARRA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.032956	IL

General Provider Information

NPI Number	:	1053298174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA IBARRA FNP-BC

Provider Business Mailing Address
First Line	:	5521 S KEDZIE AVE UNIT 106
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2448
Country	:	US
Telephone Number	:	773-306-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	6524 RIDGE DR
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1827
Country	:	US
Telephone Number	:	773-663-1664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2025
Last Update Date	:	12/14/2025

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