Provider Demographics
NPI:1639788151
Name:HERRERA, IRINA ALEJANDRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:ALEJANDRA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-2630
Mailing Address - Country:US
Mailing Address - Phone:813-373-9531
Mailing Address - Fax:
Practice Address - Street 1:2282 CIMARRON TER
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-4900
Practice Address - Country:US
Practice Address - Phone:727-412-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health