Provider Demographics
NPI:1275870651
Name:KANTOR, DEBORAH E (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:KANTOR
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 1:6320 VENTURE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5130
Mailing Address - Country:US
Mailing Address - Phone:941-907-1595
Mailing Address - Fax:941-761-6888
Practice Address - Street 1:5460 63RD ST E
Practice Address - Street 2:SUITE A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-7808
Practice Address - Country:US
Practice Address - Phone:941-758-0379
Practice Address - Fax:941-272-7503
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner