Provider Demographics
NPI:1154754711
Name:SWIDERSKI, IRIS JEANNE (DHSC, PA-C)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:JEANNE
Last Name:SWIDERSKI
Suffix:
Gender:F
Credentials:DHSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7676
Mailing Address - Country:US
Mailing Address - Phone:631-252-7945
Mailing Address - Fax:
Practice Address - Street 1:21298 OLEAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6705
Practice Address - Country:US
Practice Address - Phone:941-629-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058839363A00000X
MI5601011329363A00000X
NY016860363A00000X
NJ25MP00627300363A00000X
VA0110007964363A00000X
SCMPA.5834363AS0400X
MO2023009774363AS0400X
NC0010-13160363AS0400X
FL9109495363AS0400X
MAPA9389363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant