Provider Demographics
NPI:1902134505
Name:OWENS, IRENE MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:MARIE
Last Name:OWENS
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 1:33541 EAST LAKE JOANNA DRIVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736
Mailing Address - Country:US
Mailing Address - Phone:352-383-1554
Mailing Address - Fax:
Practice Address - Street 1:1210 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-787-8489
Practice Address - Fax:352-787-8718
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1099562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily