Provider Demographics
NPI:1194458315
Name:DZURILLOVA, IVONA
Entity type:Individual
Prefix:
First Name:IVONA
Middle Name:
Last Name:DZURILLOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVONNE
Other - Middle Name:M
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:113 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33786-3216
Mailing Address - Country:US
Mailing Address - Phone:908-603-7791
Mailing Address - Fax:
Practice Address - Street 1:2750 SOUTHSHORE AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-5022
Practice Address - Country:US
Practice Address - Phone:813-828-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9419507163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine