Provider Demographics
NPI:1821041716
Name:IRVING, JOANN (ARNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:IRVING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:
Other - Last Name:BABUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2675 WINKLER AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:13823 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2069
Practice Address - Country:US
Practice Address - Phone:941-888-0770
Practice Address - Fax:941-888-0778
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9216693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY084ROtherFL BC
FLY084RZMedicare ID - Type Unspecified
Q68902Medicare UPIN
FLY084ROtherFL BC