MEDICARE: MRS. BARBARA IRIZARRY-LUKE RN

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	163W00000X	Registered Nurse	RN9212291	FL
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN9212291	FL
3	163WC0400X	Case Management Registered Nurse	RN9212291	FL
4	163WD0400X	Diabetes Educator Registered Nurse	RN9212291	FL
5	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	RN9212291	FL
6	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN9212291	FL
7	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN9212291	FL

General Provider Information

NPI Number	:	1053613117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA IRIZARRY-LUKE RN

Provider Business Mailing Address
First Line	:	2006 N.46TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021
Country	:	US
Telephone Number	:	954-534-5773
Fax Number	:	754-816-3071

Provider Business Practice Location Address
First Line	:	3127 W. HALLANDALE BEACH BLVD.
Second Line	:	SUITE 115
City	:	PEMBROKE PARK
State	:	FL
Zip	:	33009
Country	:	US
Telephone Number	:	754-816-3071
Fax Number	:	754-816-3077

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	11/23/2010

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