Provider Demographics
NPI:1336685700
Name:SPEARS, DEANNA CHARISSE (RN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:CHARISSE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W SEMINOLE BLVD
Mailing Address - Street 2:DIABETES CARE CENTER
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6743
Mailing Address - Country:US
Mailing Address - Phone:407-562-0976
Mailing Address - Fax:407-833-7534
Practice Address - Street 1:1401 W SEMINOLE BLVD
Practice Address - Street 2:DIABETES CARE CENTER
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6743
Practice Address - Country:US
Practice Address - Phone:407-562-0976
Practice Address - Fax:407-833-7534
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9285389163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator