Provider Demographics
NPI:1922467646
Name:APONTE MORENO, IRENE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:APONTE MORENO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:APONTE
Other - Last Name:DIVALENTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 SW PERIMETER GLEN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-719-9663
Mailing Address - Fax:
Practice Address - Street 1:440 SW PERIMETER GLEN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-719-9663
Practice Address - Fax:866-300-2396
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9393761363L00000X
FLRN9393761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner