Provider Demographics
NPI:1104132059
Name:HERRAN, IVONNE (AP)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:HERRAN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 LAKESIDE DR APT 103
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7659
Mailing Address - Country:US
Mailing Address - Phone:954-856-9349
Mailing Address - Fax:
Practice Address - Street 1:23008 SANDALFOOT PLAZA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-6654
Practice Address - Country:US
Practice Address - Phone:954-856-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist