Provider Demographics
NPI:1073967287
Name:FONSECA, DEBRA (ARNP-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 GUNBARREL RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3126
Mailing Address - Country:US
Mailing Address - Phone:423-541-5102
Mailing Address - Fax:423-541-5104
Practice Address - Street 1:1635 GUNBARREL RD STE 110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3126
Practice Address - Country:US
Practice Address - Phone:423-541-5102
Practice Address - Fax:423-541-5104
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24231363LF0000X
FLARNP9266321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily