Provider Demographics
NPI:1205659406
Name:GARCIA, IRINA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:GARCIA
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 1:4919 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2714
Mailing Address - Country:US
Mailing Address - Phone:786-201-4723
Mailing Address - Fax:
Practice Address - Street 1:13005 SOUTHERN BLVD STE 214
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9272
Practice Address - Country:US
Practice Address - Phone:561-855-1999
Practice Address - Fax:561-855-1999
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119293363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical