Provider Demographics
NPI:1235109497
Name:ROLLINS, DEANNA L (ARNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16264
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33766-6264
Mailing Address - Country:US
Mailing Address - Phone:727-287-2784
Mailing Address - Fax:727-669-9260
Practice Address - Street 1:22089 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2364
Practice Address - Country:US
Practice Address - Phone:727-287-2784
Practice Address - Fax:727-669-9260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP924312363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY053VOtherBCBS
Q26294Medicare UPIN
FLY053VZMedicare ID - Type Unspecified