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Individual

MRS. JOHANNA IVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NNP-BC

Contact information

Practice address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 467-4770
(813) 467-4243
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812

Taxonomy

Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
ARNP9363820
FL
363L00000X
Nurse Practitioner
ARNP9363820
FL
363LN0000X
Neonatal Nurse Practitioner
Primary
APRN9363820
FL
363LN0005X
Critical Care Neonatal Nurse Practitioner
ARNP9363820
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100145500
FL
01
AL8JF
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/07/2013
Last updated
02/19/2025
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