Provider Demographics
NPI:1134683824
Name:POWELL, DEBORAH LEVENS (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEVENS
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2569 BREEZY LN
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-7809
Mailing Address - Country:US
Mailing Address - Phone:850-373-6515
Mailing Address - Fax:
Practice Address - Street 1:2569 BREEZY LN
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-7809
Practice Address - Country:US
Practice Address - Phone:850-373-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily