Provider Demographics
NPI:1093819781
Name:BABCOCK, DEBRA L (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 EXECUTIVE LN STE 1110
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3595
Mailing Address - Country:US
Mailing Address - Phone:321-394-8000
Mailing Address - Fax:321-394-8002
Practice Address - Street 1:830 EXECUTIVE LN STE 1110
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3595
Practice Address - Country:US
Practice Address - Phone:321-394-8000
Practice Address - Fax:321-394-8002
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003213363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical