Provider Demographics
NPI:1003352535
Name:IBE, CECILIA IFEOMA (ARNP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:IFEOMA
Last Name:IBE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23916 NW 83RD AVE FL 32026
Mailing Address - Street 2:
Mailing Address - City:RAIFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32083-1003
Mailing Address - Country:US
Mailing Address - Phone:904-368-2500
Mailing Address - Fax:
Practice Address - Street 1:23916 NW 83RD AVENUE
Practice Address - Street 2:
Practice Address - City:RAIFORD
Practice Address - State:FL
Practice Address - Zip Code:32026-2648
Practice Address - Country:US
Practice Address - Phone:904-368-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-08
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9251837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily