Provider Demographics
NPI:1114617560
Name:IRIZARRY, BIANCA MIKAELA (PA-C)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:MIKAELA
Last Name:IRIZARRY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 NW 96TH DR APT 204
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-0122
Mailing Address - Country:US
Mailing Address - Phone:386-292-6861
Mailing Address - Fax:
Practice Address - Street 1:2264 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3680
Practice Address - Country:US
Practice Address - Phone:352-642-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9116886OtherFLORIDA DEPARTMENT OF HEALTH