Individual
TERRELL IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 N. FREDERICK AVE, DAYTONA BEACH, FL 32114
(386) 255-5569
(386) 255-5277
Mailing address
240 N. FREDERICK AVE, DAYTONA BEACH, FL 32114
(386) 255-5569
(386) 255-5277
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016684900
—
FL
Enumeration date
08/31/2016
Last updated
08/31/2016
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