Provider Demographics
NPI:1144206574
Name:CONDOSTA, DEBORAH B (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:B
Last Name:CONDOSTA
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 HAPPY ACRES LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4605
Mailing Address - Country:US
Mailing Address - Phone:813-681-6845
Mailing Address - Fax:813-685-7403
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-681-5658
Practice Address - Fax:813-681-5250
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79472-2363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7186ZMedicare ID - Type Unspecified
FLS59059Medicare UPIN