Provider Demographics
NPI:1053501379
Name:SKORUPPA, DEBORAH SUSAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUSAN
Last Name:SKORUPPA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 PRAIRIE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-5898
Mailing Address - Country:US
Mailing Address - Phone:361-387-3779
Mailing Address - Fax:
Practice Address - Street 1:5348 PRAIRIE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380
Practice Address - Country:US
Practice Address - Phone:361-387-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287541102Medicaid