Provider Demographics
NPI:1891030417
Name:IBARRA, GRECIA SOFIA (ARNP)
Entity type:Individual
Prefix:
First Name:GRECIA
Middle Name:SOFIA
Last Name:IBARRA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19119 DOVE RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2592
Mailing Address - Country:US
Mailing Address - Phone:813-679-6236
Mailing Address - Fax:813-308-5500
Practice Address - Street 1:8407 PINEHURST DR STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1532
Practice Address - Country:US
Practice Address - Phone:813-850-0050
Practice Address - Fax:813-308-5500
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9314378208M00000X, 363LP0808X
KY4030433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104499900Medicaid