Provider Demographics
NPI:1205814985
Name:BADRI, DEBITA TEJWANTIE (ARNP C)
Entity Type:Individual
Prefix:MS
First Name:DEBITA
Middle Name:TEJWANTIE
Last Name:BADRI
Suffix:
Gender:F
Credentials:ARNP C
Other - Prefix:MS
Other - First Name:DEBITA
Other - Middle Name:TEJWANTIE
Other - Last Name:PERSAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2747 GRANTHAM CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6170
Mailing Address - Country:US
Mailing Address - Phone:407-292-5596
Mailing Address - Fax:
Practice Address - Street 1:7599 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5109
Practice Address - Country:US
Practice Address - Phone:407-353-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2016692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3424YMedicare UPIN
FLCCN920425785203Medicare ID - Type Unspecified
Q25195Medicare UPIN