Provider Demographics
NPI:1073505459
Name:MOULAVI, DEBBIE LYNN (NP C)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:LYNN
Last Name:MOULAVI
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:L
Other - Last Name:MOULAVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP C
Mailing Address - Street 1:2284 RED EMBER RD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9763
Mailing Address - Country:US
Mailing Address - Phone:407-359-6426
Mailing Address - Fax:407-359-6426
Practice Address - Street 1:2284 RED EMBER RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9763
Practice Address - Country:US
Practice Address - Phone:407-359-6426
Practice Address - Fax:407-359-6426
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1498402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302942500Medicaid
FLY8233ZOtherPTAN
Y8233OtherB/C B/S FL
FLY8233YOtherPTAN
1073505459OtherMEDICARE NPI
500017814Medicare ID - Type UnspecifiedTRAVELERS/RAILROAD
1073505459OtherMEDICARE NPI