Provider Demographics
NPI:1144903428
Name:IRELAND, VASHAWN THERESA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:VASHAWN
Middle Name:THERESA
Last Name:IRELAND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9522 NW 65TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-3550
Mailing Address - Country:US
Mailing Address - Phone:954-552-3495
Mailing Address - Fax:
Practice Address - Street 1:9522 NW 65TH ST
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-3550
Practice Address - Country:US
Practice Address - Phone:954-552-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty