Provider Demographics
NPI:1386699866
Name:HALLOCK, IRENE DOROTHY (FNP)
Entity type:Individual
Prefix:MISS
First Name:IRENE
Middle Name:DOROTHY
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2102 CROMLEY CIR STE B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3187
Mailing Address - Country:US
Mailing Address - Phone:843-839-5286
Mailing Address - Fax:843-353-2528
Practice Address - Street 1:2102 CROMLEY CIR STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3187
Practice Address - Country:US
Practice Address - Phone:843-839-2865
Practice Address - Fax:843-353-2528
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94V11Medicare ID - Type Unspecified