Provider Demographics
NPI:1003384298
Name:DE LEON, IRINA (APRN)
Entity Type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20503 SW 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6170
Mailing Address - Country:US
Mailing Address - Phone:305-726-6755
Mailing Address - Fax:
Practice Address - Street 1:20503 SW 133RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6170
Practice Address - Country:US
Practice Address - Phone:305-726-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner