Provider Demographics
NPI:1588972202
Name:NYACK, IRMA (RN,BSN,MBA)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:NYACK
Suffix:
Gender:F
Credentials:RN,BSN,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 LAKE WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6070
Mailing Address - Country:US
Mailing Address - Phone:407-484-2303
Mailing Address - Fax:407-258-8225
Practice Address - Street 1:606 WEST AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2175
Practice Address - Country:US
Practice Address - Phone:407-484-2303
Practice Address - Fax:407-258-8225
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002455400Medicaid