Provider Demographics
NPI:1922189190
Name:IRWIN, COLLEEN ANNE (FNP-C, PMHNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:FNP-C, PMHNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:ASTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, PMHNP
Mailing Address - Street 1:4905 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4309
Mailing Address - Country:US
Mailing Address - Phone:407-392-9244
Mailing Address - Fax:
Practice Address - Street 1:4905 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4309
Practice Address - Country:US
Practice Address - Phone:407-392-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9379521363LP0808X, 363L00000X
GARN150271 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily