Provider Demographics
NPI:1043966690
Name:CABRERA, IRISH JEREZA (FNP-C)
Entity Type:Individual
Prefix:
First Name:IRISH
Middle Name:JEREZA
Last Name:CABRERA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:IRISH
Other - Middle Name:DEDEL
Other - Last Name:JEREZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18807 N 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4846
Mailing Address - Country:US
Mailing Address - Phone:602-670-8773
Mailing Address - Fax:
Practice Address - Street 1:19829 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4001
Practice Address - Country:US
Practice Address - Phone:623-879-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ271049363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner