Provider Demographics
NPI:1801485545
Name:RENFROE, ILANA ROBBINS (RN, NP)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:ROBBINS
Last Name:RENFROE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 IVANHOE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4507
Mailing Address - Country:US
Mailing Address - Phone:858-554-1212
Mailing Address - Fax:
Practice Address - Street 1:7855 IVANHOE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4507
Practice Address - Country:US
Practice Address - Phone:858-554-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN240646163W00000X
CA95207886163W00000X
CA95016239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse