Provider Demographics
NPI:1366224495
Name:KASPEROVICH, IRINA (FNP-C)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KASPEROVICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 CARAWAY DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4171
Mailing Address - Country:US
Mailing Address - Phone:773-930-8731
Mailing Address - Fax:
Practice Address - Street 1:2344 CARAWAY DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4171
Practice Address - Country:US
Practice Address - Phone:773-930-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily