Provider Demographics
NPI:1992755896
Name:NAZARIO, ILKA YADIRA (MD)
Entity type:Individual
Prefix:DR
First Name:ILKA
Middle Name:YADIRA
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ILKA
Other - Middle Name:YADIRA
Other - Last Name:NAZARIO PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4437 AMBERLY OAKS CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1409
Mailing Address - Country:US
Mailing Address - Phone:813-484-4484
Mailing Address - Fax:
Practice Address - Street 1:3355 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2100
Practice Address - Country:US
Practice Address - Phone:813-893-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036158035207R00000X
FLME92944208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME92944OtherFL MEDICAL LICENSE
IL036.158035OtherIL MEDICAL LICENSE
IDM-14028OtherID MEDICAL LICENSE