Provider Demographics
NPI:1023024700
Name:IRIZARRY, JOHANNA (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 W FOREST HILL BLVD
Mailing Address - Street 2:STE 182
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5700
Mailing Address - Country:US
Mailing Address - Phone:561-798-4221
Mailing Address - Fax:
Practice Address - Street 1:12230 W FOREST HILL BLVD
Practice Address - Street 2:STE 182
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5700
Practice Address - Country:US
Practice Address - Phone:561-798-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL071268367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5023ZMedicare PIN