Provider Demographics
NPI:1679971196
Name:GARCIA, IVELISSE (APRN)
Entity Type:Individual
Prefix:MS
First Name:IVELISSE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 S MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5711
Mailing Address - Country:US
Mailing Address - Phone:813-571-9988
Mailing Address - Fax:
Practice Address - Street 1:270 S MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5711
Practice Address - Country:US
Practice Address - Phone:813-571-9988
Practice Address - Fax:813-571-9922
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1114285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNBYAOOtherBLUE CROSS BLUE SHIELD