Provider Demographics
NPI:1306819420
Name:LANDIS-NUSSBAUM, DEBBIE (ARNP CNM)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:LANDIS-NUSSBAUM
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:LANDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:401 CORBETT ST
Practice Address - Street 2:STE 400
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-7309
Practice Address - Country:US
Practice Address - Phone:727-462-2229
Practice Address - Fax:727-447-5610
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1939462363L00000X
FLARNP1939462367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1215135090OtherGROUP NPI
FL251910101Medicaid
FL251910100Medicaid
FL1215135090OtherGROUP NPI
FL251910100Medicaid