Provider Demographics
NPI:1285658047
Name:WEAVER, DEBRA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4671
Mailing Address - Country:US
Mailing Address - Phone:850-942-5585
Mailing Address - Fax:850-222-1194
Practice Address - Street 1:2880 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4671
Practice Address - Country:US
Practice Address - Phone:850-942-5585
Practice Address - Fax:850-222-1194
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03599103T00000X
FLPY4836103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59382OtherBLUE CROSS/BLUE SHIELD OF FLORIDA