Provider Demographics
NPI:1124045745
Name:RUOCCO, DEBRALEE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRALEE
Middle Name:ANNE
Last Name:RUOCCO
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 1:3000 CORAL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4108
Mailing Address - Country:US
Mailing Address - Phone:954-344-3108
Mailing Address - Fax:
Practice Address - Street 1:3000 CORAL HILLS DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4108
Practice Address - Country:US
Practice Address - Phone:954-344-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9102726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292623700Medicaid
FL292623700Medicaid
FLU6555YMedicare PIN
FLU6555WMedicare PIN