Provider Demographics
NPI:1073522942
Name:GUTSALYUK, IRINA (PA)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:GUTSALYUK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:TSUR-TSAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20800
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4105
Mailing Address - Country:US
Mailing Address - Phone:888-402-7256
Mailing Address - Fax:888-902-1099
Practice Address - Street 1:370 SOUTHEAST VERANDA FALLS WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984
Practice Address - Country:US
Practice Address - Phone:772-763-1720
Practice Address - Fax:772-214-3027
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009810-1363AS0400X
FLPA9109303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical