Provider Demographics
NPI:1316530553
Name:IRIZARRY, CHERITH VICTORIA (FNP)
Entity type:Individual
Prefix:MS
First Name:CHERITH
Middle Name:VICTORIA
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:
Practice Address - Street 1:4425 E US HIGHWAY 377 STE 104
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7475
Practice Address - Country:US
Practice Address - Phone:682-936-4081
Practice Address - Fax:817-570-0704
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily