Provider Demographics
NPI:1134952757
Name:GRECIA S IBARRA APRN LLC
Entity type:Organization
Organization Name:GRECIA S IBARRA APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRECIA
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-850-0050
Mailing Address - Street 1:19119 DOVE RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2592
Mailing Address - Country:US
Mailing Address - Phone:813-850-0050
Mailing Address - Fax:813-308-5500
Practice Address - Street 1:8407 PINEHURST DR STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1532
Practice Address - Country:US
Practice Address - Phone:813-850-0050
Practice Address - Fax:813-308-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty