Provider Demographics
NPI:1154940500
Name:IRWIN, PATRICIA EMERSON
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EMERSON
Last Name:IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1469
Mailing Address - Country:US
Mailing Address - Phone:813-951-5323
Mailing Address - Fax:
Practice Address - Street 1:4144 N ARMENIA AVE STE 350
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6434
Practice Address - Country:US
Practice Address - Phone:855-743-4273
Practice Address - Fax:855-743-4273
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH4733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health