Provider Demographics
NPI:1073903639
Name:ALLEN, DEBRA (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1512
Mailing Address - Country:US
Mailing Address - Phone:321-269-6530
Mailing Address - Fax:321-269-2334
Practice Address - Street 1:3300 DAIRY RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1512
Practice Address - Country:US
Practice Address - Phone:321-269-6530
Practice Address - Fax:321-269-2334
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1189412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIX474ZMedicare PIN