MEDICARE: GRECIA SOFIA IBARRA ARNP

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	208M00000X	Hospitalist Physician	APRN9314378	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9314378	FL
3	363LF0000X	Family Nurse Practitioner	4030433	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891030417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRECIA SOFIA IBARRA ARNP

Provider Business Mailing Address
First Line	:	19119 DOVE RD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-2592
Country	:	US
Telephone Number	:	813-679-6236
Fax Number	:	813-308-5500

Provider Business Practice Location Address
First Line	:	8407 PINEHURST DR STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1532
Country	:	US
Telephone Number	:	813-850-0050
Fax Number	:	813-308-5500

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

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	11/15/2024

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