Provider Demographics
NPI:1518402684
Name:KASUMOVA, IRYNA V (AGACNP-BC, MSN, CWS)
Entity Type:Individual
Prefix:MS
First Name:IRYNA
Middle Name:V
Last Name:KASUMOVA
Suffix:
Gender:F
Credentials:AGACNP-BC, MSN, CWS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:400 PINELLAS ST STE 325
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3320
Practice Address - Country:US
Practice Address - Phone:727-298-6121
Practice Address - Fax:727-298-6151
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN93156232083P0011X, 363L00000X
FL9315623363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114956300Medicaid