Provider Demographics
NPI:1407359946
Name:IBARRA, DEBORAH VIRGEN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:VIRGEN
Last Name:IBARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 SW 213TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3734
Mailing Address - Country:US
Mailing Address - Phone:305-807-2099
Mailing Address - Fax:
Practice Address - Street 1:9350 SUNSET DR STE 151
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3286
Practice Address - Country:US
Practice Address - Phone:786-548-1022
Practice Address - Fax:786-542-5326
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9281497363LF0000X
FLAPRN9281497363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily