Provider Demographics
NPI:1932171337
Name:PACANOWSKA-ASSEFA, IRENA MARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:IRENA
Middle Name:MARIA
Last Name:PACANOWSKA-ASSEFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ZEAGLER DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3860
Mailing Address - Country:US
Mailing Address - Phone:386-328-6746
Mailing Address - Fax:386-328-7554
Practice Address - Street 1:700 ZEAGLER DRIVE
Practice Address - Street 2:SUITE 10
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3860
Practice Address - Country:US
Practice Address - Phone:386-328-6746
Practice Address - Fax:386-328-7554
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067444207Q00000X
FLME67444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109579200Medicaid
FL372143400Medicaid
FL376985200Medicaid
FL372143401Medicaid
FL376985200Medicaid
103846Medicare PIN
FL372143400Medicaid