Provider Demographics
NPI:1871028647
Name:IRIZARRY, KRYSTLE RENEE (DO)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:RENEE
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:RENEE
Other - Last Name:IRIZARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KRYSTLE MORRIS
Mailing Address - Street 1:515 WEKIVA COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3645
Mailing Address - Country:US
Mailing Address - Phone:407-464-9516
Mailing Address - Fax:407-464-9519
Practice Address - Street 1:515 WEKIVA COMMONS CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3645
Practice Address - Country:US
Practice Address - Phone:407-464-9516
Practice Address - Fax:407-464-9519
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO22718207Q00000X
FLOS15671208M00000X, 207Q00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program