Provider Demographics
NPI:1851531552
Name:BOYD, IRENE WILCOX
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:WILCOX
Last Name:BOYD
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 1:220 SW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-0277
Mailing Address - Country:US
Mailing Address - Phone:352-493-0360
Mailing Address - Fax:352-493-0369
Practice Address - Street 1:1411 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1976
Practice Address - Country:US
Practice Address - Phone:352-493-0360
Practice Address - Fax:352-493-0369
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1427284272OtherTRI-COUNTY ORTHOTIC PROSTHETIC INSTITUTE
FL1427284272OtherTRI-COUNTY ORTHOTIC PROSTHETIC INSTITUTE
FL1427284272OtherTRI-COUNTY ORTHOTIC PROSTHETIC INSTITUTE