Provider Demographics
NPI:1134769763
Name:IBARRA, YILKA PAOLA (TCM)
Entity type:Individual
Prefix:MRS
First Name:YILKA
Middle Name:PAOLA
Last Name:IBARRA
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7860
Mailing Address - Country:US
Mailing Address - Phone:407-883-2062
Mailing Address - Fax:
Practice Address - Street 1:2910 WINDMILL DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7860
Practice Address - Country:US
Practice Address - Phone:407-883-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator