Provider Demographics
NPI:1033582895
Name:AHUATZIN, OSIRIS IZCHELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:OSIRIS
Middle Name:IZCHELL
Last Name:AHUATZIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5162 LINTON BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6567
Mailing Address - Country:US
Mailing Address - Phone:561-498-4010
Mailing Address - Fax:561-498-4011
Practice Address - Street 1:3026 ROCKVILLE LN
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8299
Practice Address - Country:US
Practice Address - Phone:561-676-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9347533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily