| Doctor Name: | DR. MARY THERESA IZZO |
| NPI Number: | 1023145752 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, ARNP |
| License Number: | 0876802 |
| Business Practice Address: | 862 Peachwood Dr Deland, FL - 327200834 |
| Business Phone Number: | 3867407080 |
| Business Fax Number: | 3867340821 |
| Mailing Address: | 862 Peachwood Drive, DELAND |
| State: | FL |
| Postal Code: | 327203215 |
| Phone Number: | 3867407080 |
| Fax Number: | 3867340821 |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 08/03/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0876802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |